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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables Page 1 National Ambulatory Medical Care Survey: 2015 State and National Summary Tables The Ambulatory and Hospital Care Statistics Branch is pleased to release the most current nationally representative data on ambulatory care visits to physician offices in the United States. Statistics are presented on physician practices as well as patient and visit characteristics using data collected in the 2015 National Ambulatory Medical Care Survey (NAMCS). NAMCS is an annual nationally representative sample survey of visits to nonfederal office-based patient care physicians, excluding anesthesiologists, radiologists, and pathologists. Visit estimates for the following 16 states that were targeted for separate estimation are included in the summary tables: Arizona, California, Florida, Georgia, Illinois, Indiana, Massachusetts, Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Texas, Virginia, and Washington. The remaining 34 states and DC were grouped into four region remainders (North, South, East, and West) or groups of states that comprise Census regions excluding the 16 states for which state estimates were calculated. Four tables presenting state estimates are included, in addition to the tables presenting national estimates. The sampling frame for the 2015 NAMCS was composed of physicians listed in the master files maintained by the American Medical Association and the American Osteopathic Association. The 2015 NAMCS utilized a two-stage probability design that involved probability samples of physicians within targeted states and Census regions, and patient visits within practices. Although an additional sample of physicians and non-physician practitioners from community health center (CHC) delivery sites was also selected, CHC estimates are not included in the summary tables and will be presented in a separate report. The 2015 NAMCS sample included 8,091 physicians. A total of 3,181 physicians did not meet all of the criteria and were ruled out of scope (ineligible) for the study. Of the 4,910 in- scope (eligible) physicians, 1,410 completed Patient Record Forms (PRFs) in the study. PRFs were not completed by 327 physicians because they saw no patients during their sample week due to vacation, illness, or other reasons for being temporarily not in practice. Of the 1,410 physicians who completed PRFs, 1,088 participated fully or adequately (i.e. at least half of the PRFs expected, based on the total number of visits during the reporting week, were submitted), and 322 participated minimally (i.e. fewer than half of the expected number of PRFs were submitted). Within physician practices, data are abstracted from medical records for up to 30 sampled visits during a randomly assigned 1-week reporting period. In all, 28,332 PRFs were submitted. The participation rate—the percentage of in-scope physicians for whom at least one PRF was completed—was 36.5% percent. The response rate—the percentage of in-scope physicians for whom at least one-half of their expected number of PRFs was completed—was 29.6%. Among the 16 targeted states, response rates ranged from 14.3% to 55.6%. The 2015 NAMCS was conducted from December 22, 2014, through December 20, 2015. The U.S. Bureau of the Census was the data collection agent for the 2015 NAMCS. NAMCS was collected electronically, using a computerized instrument developed by the U.S. Census Bureau. For 2015, abstraction by Census field representatives using laptop computers to access the automated PRF instrument was the preferred mode of data collection. The PRF may be viewed at: https://www.cdc.gov/nchs/data/ahcd/2015_NAMCS_PRF_Sample_Card.pdf. Data processing and medical coding were performed by SRA International, Inc., Durham, North Carolina. As part of the quality assurance procedure, a 10% quality control sample of NAMCS survey records were independently recoded and compared. Differences were adjudicated by a quality control supervisor with error rates reported to NCHS. Coding error rates for the 10% sample ranged between 0.5 and 1.4%. For further details, see the 2015 NAMCS

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Page 1: National Ambulatory Medical Care Survey: 2015 State and ...€¦ · National Ambulatory Medical Care Survey: 2015 State and National Summary Tables Page 1 . National Ambulatory Medical

National Ambulatory Medical Care Survey: 2015 State and National Summary Tables  Page 1

National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

The Ambulatory and Hospital Care Statistics Branch is pleased to release the most current nationally representative data on ambulatory care visits to physician offices in the United States. Statistics are presented on physician practices as well as patient and visit characteristics using data collected in the 2015 National Ambulatory Medical Care Survey (NAMCS). NAMCS is an annual nationally representative sample survey of visits to nonfederal office-based patient care physicians, excluding anesthesiologists, radiologists, and pathologists. Visit estimates for the following 16 states that were targeted for separate estimation are included in the summary tables: Arizona, California, Florida, Georgia, Illinois, Indiana, Massachusetts, Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Texas, Virginia, and Washington. The remaining 34 states and DC were grouped into four region remainders (North, South, East, and West) or groups of states that comprise Census regions excluding the 16 states for which state estimates were calculated. Four tables presenting state estimates are included, in addition to the tables presenting national estimates.

The sampling frame for the 2015 NAMCS was composed of physicians listed in the master files maintained by the American Medical Association and the American Osteopathic Association. The 2015 NAMCS utilized a two-stage probability design that involved probability samples of physicians within targeted states and Census regions, and patient visits within practices. Although an additional sample of physicians and non-physician practitioners from community health center (CHC) delivery sites was also selected, CHC estimates are not included in the summary tables and will be presented in a separate report.

The 2015 NAMCS sample included 8,091 physicians. A total of 3,181 physicians did not meet all of the criteria and were ruled out of scope (ineligible) for the study. Of the 4,910 in- scope (eligible) physicians, 1,410 completed Patient Record Forms (PRFs) in the study. PRFs were not completed by 327 physicians because they saw no patients during their sample week due to vacation, illness, or other reasons for being temporarily not in practice. Of the 1,410 physicians who completed PRFs, 1,088 participated fully or adequately (i.e. at least half of the PRFs expected, based on the total number of visits during the reporting week, were submitted), and 322 participated minimally (i.e. fewer than half of the expected number of PRFs were submitted). Within physician practices, data are abstracted from medical records for up to 30 sampled visits during a randomly assigned 1-week reporting period. In all, 28,332 PRFs were submitted. The participation rate—the percentage of in-scope physicians for whom at least one PRF was completed—was 36.5% percent. The response rate—the percentage of in-scope physicians for whom at least one-half of their expected number of PRFs was completed—was 29.6%. Among the 16 targeted states, response rates ranged from 14.3% to 55.6%.

The 2015 NAMCS was conducted from December 22, 2014, through December 20, 2015. The U.S. Bureau of the Census was the data collection agent for the 2015 NAMCS. NAMCS was collected electronically, using a computerized instrument developed by the U.S. Census Bureau. For 2015, abstraction by Census field representatives using laptop computers to access the automated PRF instrument was the preferred mode of data collection. The PRF may be viewed at: https://www.cdc.gov/nchs/data/ahcd/2015_NAMCS_PRF_Sample_Card.pdf.

Data processing and medical coding were performed by SRA International, Inc., Durham, North Carolina. As part of the quality assurance procedure, a 10% quality control sample of NAMCS survey records were independently recoded and compared. Differences were adjudicated by a quality control supervisor with error rates reported to NCHS. Coding error rates for the 10% sample ranged between 0.5 and 1.4%. For further details, see the 2015 NAMCS

Page 2: National Ambulatory Medical Care Survey: 2015 State and ...€¦ · National Ambulatory Medical Care Survey: 2015 State and National Summary Tables Page 1 . National Ambulatory Medical

National Ambulatory Medical Care Survey: 2015 State and National Summary Tables  Page 2

Public Use Data File Documentation at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_ Documentation/NAMCS/doc2015.pdf.

Web table estimates consist of visits to physicians at office-based practices. Visit estimates are based on sample data weighted to produce annual national estimates and include standard errors. Because of the complex multistage design of NAMCS, a sample weight is computed for each sample visit that takes all stages of design into account. The survey data are inflated or weighted to produce national annual estimates. The visit weight includes four basic components: inflation by reciprocals of selection probabilities, adjustment for nonresponse, population ratio adjustments, and weight smoothing. Estimates of the sampling variability were calculated using Taylor approximations in SUDAAN, which take into account the complex sample design of NAMCS. Detailed information on the design, conduct, and estimation procedures of the 2015 NAMCS are discussed in the NAMCS Public Use Data File Documentation.

As in any survey, results are subject to sampling and nonsampling errors. Nonsampling errors include reporting and processing errors as well as biases due to nonresponse and incomplete response. In 2015, race data were missing for 28.6% of visits, and ethnicity data were missing for 23.4% of visits. Starting with 2009 data, NAMCS adopted the technique of model-based single imputation for NAMCS race and ethnicity data. Race imputation is restricted to three categories (white, black, and other) based on research by an internal work group and on quality concerns with imputed estimates for race categories other than white and black. The imputation technique is described in more detail in the 2015 NAMCS Public Use Data File Documentation (see above for link). Information on missing data for other variables is provided in table footnotes.

In the following tables, estimates are not presented and replaced with an asterisk (*) if they are based on fewer than 30 cases in the sample data. Estimates based on 30 or more cases include an asterisk if the relative standard error (RSE) of the estimate exceeds 30 percent.

Suggested citation: Rui P, Okeyode T. National Ambulatory Medical Care Survey: 2015 State and National Summary Tables. Available from: http://www.cdc.gov/nchs/ahcd/ahcd_ products.htm.

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 1. Physician office visits, by selected physician characteristics: United States, 2015

Number of visits per Number of visits in thousands Percent distribution 100 persons per year1,2,3

Physician characteristic (standard error in thousands) (standard error of percent) (standard error of rate)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 (49,038) 100�0 ��� 313�3 (15�5)

Physician specialty4

General and family practice � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 192,789 (31,485) 19�5 (2�8) 61�0 (10�0) Internal medicine � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 139,028 (29,149) 14�0 (2�7) 44�0 (9�2) Pediatrics5� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 94,861 (12,045) 9�6 (1�3) 122�6 (15�8) Obstetrics and gynecology6 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 81,045 (13,273) 8�2 (1�4) 61�0 (10�0) Ophthalmology � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 57,938 (8,095) 5�8 (0�8) 18�3 (2�6) Orthopedic surgery� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 56,427 (8,367) 5�7 (0�9) 17�8 (2�6) Psychiatry � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 45,863 (9,509) 4�6 (1�0) 14�5 (3�0) Cardiovascular diseases� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 41,223 (8,033) 4�2 (0�8) 13�0 (2�5) Dermatology � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 37,110 (5,515) 3�7 (0�6) 11�7 (1�7) Otolaryngology � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 24,798 (3,320) 2�5 (0�4) 7�8 (1�0) Urology � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 20,735 (2,677) 2�1 (0�3) 6�6 (0�8) General surgery � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 16,806 (2,556) 1�7 (0�3) 5�3 (0�8) Neurology � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 15,635 (3,521) 1�6 (0�4) 4�9 (1�1) All other specialties� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 166,552 (31,285) 16�8 (2�8) 52�7 (9�9)

Professional identity

Doctor of medicine � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 933,628 (49,194) 94�2 (1�3) 295�2 (15�6) Doctor of osteopathy� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 57,180 (12,491) 5�8 (1�3) 18�1 (3�9)

Specialty type4

Primary care � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 505,522 (38,066) 51�0 (2�6) 159�8 (12�0) Medical specialty � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 281,430 (32,708) 28�4 (2�7) 89�0 (10�3) Surgical specialty � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 203,856 (13,179) 20�6 (1�6) 64�5 (4�2)

Geographic region

Northeast � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 200,430 (17,743) 20�2 (1�7) 360�8 (31�9) Midwest � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 174,667 (14,124) 17�6 (1�4) 261�0 (21�1) South � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 355,705 (30,239) 35�9 (2�4) 299�2 (25�4) West � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 260,007 (31,521) 26�2 (2�6) 347�0 (42�1)

Metropolitan status7

MSA � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 921,047 (48,815) 93�0 (1�3) 333�1 (17�7) Non-MSA � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 69,761 (13,263) 7�0 (1�3) 175�5 (33�4)

1Visit rates are based on the July 1, 2015, set of estimates of the civilian noninstitutional population of the United States as developed by the Population Division, U�S� Census Bureau� 2Population estimates by metropolitan statistical area defnitions status are based on estimates of the civilian noninstitutional population of the United States as of July 1, 2015, from the 2015 National Health Interview Survey, National Center for Health Statistics, compiled according to November 2009 Office of Management and Budget defnitions of core-based statistical areas� See https://www�census�gov/programs-surveys/metro-micro�html for more about metropolitan statistical defnitions� 3For geographic and metropolitan statistical area, population denominators are different for each category and thus do not add to total population rate� For other variables,the denominator is the total population� 4Physician specialty and specialty type are defned in the 2015 National Ambulatory Medical Care Survey public use fle documentation, available at: ftp://ftp�cdc�gov/pub/Health_Statistics/NCHS/ Dataset_Documentation/NAMCS/doc2015�pdf� 5Number of visits (numerator) and population estimate (denominator) consist of children under 18 years of age� 6Number of visits (numerator) and population estimate (denominator) consist of females 15 years and over� 7MSA is metropolitan statistical area�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 2. Office visits by selected states: United States, 2015

Selected states Number of visits in thousands (standard error in thousands)

Number of visits per 100 persons per year1 (standard error of rate)

All visits� � � � � � � � � � � � � � � � � � � 990,808 (49,038) 313�3 (15�5)

State

Arizona � � � � � � � � � � � � � � � � � � � California � � � � � � � � � � � � � � � � � Florida� � � � � � � � � � � � � � � � � � � � Georgia� � � � � � � � � � � � � � � � � � � Illinois � � � � � � � � � � � � � � � � � � � � Indiana � � � � � � � � � � � � � � � � � � � Massachusetts � � � � � � � � � � � � � Michigan � � � � � � � � � � � � � � � � � � New Jersey � � � � � � � � � � � � � � � � New York� � � � � � � � � � � � � � � � � � North Carolina � � � � � � � � � � � � � Ohio � � � � � � � � � � � � � � � � � � � � � Pennsylvania� � � � � � � � � � � � � � � Texas � � � � � � � � � � � � � � � � � � � � Virginia � � � � � � � � � � � � � � � � � � � Washington� � � � � � � � � � � � � � � �

19,902 (2,585) 161,353 (30,549)

56,104 (8,580) 19,527 (4,330) 29,704 (4,198) 24,596 (4,700) 17,551 (3,863) 21,874 (2,075) 47,479 (13,081) 72,661 (9,740) 20,732 (3,915) 30,720 (4,406) 38,520 (6,001) 93,724 (22,578) 30,413 (5,704) 19,578 (2,279)

296�2 (38�5) 417�8 (79�1) 281�3 (43�0) 195�1 (43�3) 234�4 (33�1) 377�2 (72�1) 261�3 (57�5) 223�0 (21�1) 536�4 (147�8) 371�6 (49�8) 211�0 (39�8) 268�5 (38�5) 305�8 (47�6) 347�5 (83�7) 372�2 (69�8) 277�4 (32�3)

1Visit rates are based on the July 1, 2015, set of estimates of the civilian noninstitutional population of the United States as developed by the Population Division, U�S� Census Bureau�

NOTE: Numbers do not add to national total because estimates are only available for 16 states�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 3. Office visits, by selected physician practice characteristics: United States, 2015

Number of visits in thousands

(standard error Percent distribution Physician practice characteristics in thousands) (standard error of percent)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 (49,038) 100�0 ���

Employment status

Full-owner � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 382,800 (39,442) 38�6 (3�1) Part-owner � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 266,604 (26,744) 26�9 (2�5) Employee � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 324,526 (31,169) 32�8 (2�8) Contractor � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � *12,993 (3,898) *1�3 (0�4) Blank1 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � *3,885 (2,944) *0�4 (0�3)

Ownership

Physician or group � � � � � � � � � � � � � � � � � � � � � � � � � � � � 792,842 (49,198) 80�0 (2�1) Other health care corporation� � � � � � � � � � � � � � � � � � � � 64,351 (12,881) 6�5 (1�3) Other hospital � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 46,258 (11,672) 4�7 (1�2) HMO2 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 17,010 (4,645) 1�7 (0�5) Medical or academic health center� � � � � � � � � � � � � � � � 29,384 (6,015) 3�0 (0�6) Other3 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � *8,372 (2,949) *0�8 (0�3) Blank1 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 32,592 (9,127) 3�3 (0�9)

Practice size

Solo � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 368,295 (38,670) 37�2 (3�1) 2 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 86,863 (13,924) 8�8 (1�4) 3–5 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 248,415 (24,309) 25�1 (2�3) 6–10 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 178,044 (22,645) 18�0 (2�2) 11 or more� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 107,749 (22,768) 10�9 (2�2) Blank1 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � *1,442 (730) *0�1 (0�1)

Type of practice

Single-specialty group � � � � � � � � � � � � � � � � � � � � � � � � � 354,447 (24,147) 35�8 (2�6) Multispecialty group � � � � � � � � � � � � � � � � � � � � � � � � � � � 267,939 (34,449) 27�0 (3�0) Solo � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 368,295 (38,670) 37�2 (3�1) Blank1 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � * ��� * ���

Office type

Private practice � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 922,208 (49,591) 93�1 (1�1) Freestanding clinic or urgicenter� � � � � � � � � � � � � � � � � � 24,904 (6,625) 2�5 (0�7) Other4 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 43,697 (7,763) 4�4 (0�8)

Electronic medical records

Yes—all electronic � � � � � � � � � � � � � � � � � � � � � � � � � � � � 750,882 (49,468) 75�8 (2�3) Yes—part paper and part electronic � � � � � � � � � � � � � � � 114,191 (14,473) 11�5 (1�5) No� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 124,382 (17,518) 12�6 (1�8) Blank1 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � *1,355 (726) *0�1 (0�1)

Practice submits claims electronically

Yes � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 902,293 (49,350) 91�1 (1�4) No� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 73,429 (12,426) 7�4 (1�3) Blank1 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � *15,087 (7,146) *1�5 (0�7)

��� Category not applicable� *Figure does not meet standards of reliability or precision� 1Blank may include missing, unknown, and/or “refused to answer the question” data� 2HMO is health maintenance organization� 3“Other” includes owners such as local government (state, county or city) and charitable organizations� 4“Other” includes the following office types: HMO, nonfederal government clinic, mental health center, family planning clinic, and faculty practice plan�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 4. Office visits, by patient age and sex: United States, 2015

Number of visits per Number of visits in thousands Percent distribution 100 persons per year1

Patient age and sex (standard error in thousands) (standard error of percent) (standard error of rate)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 (49,038) 100�0 ��� 313�3 (15�5)

Age

Under 15 years � � � � � � � � � � � � � � � � � � � � � � � � � � � 125,386 (11,829) 12�7 (1�3) 205�6 (19�4) Under 1 year � � � � � � � � � � � � � � � � � � � � � � � � � � � 24,522 (3,554) 2�5 (0�4) 616�7 (89�4) 1–4 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 38,205 (4,271) 3�9 (0�5) 239�9 (26�8) 5–14 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � 62,660 (5,758) 6�3 (0�6) 152�6 (14�0)

15–24 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 75,861 (7,688) 7�7 (0�7) 176�9 (17�9) 25–44 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 178,819 (12,919) 18�0 (1�0) 216�3 (15�6) 45–64 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 305,071 (20,537) 30�8 (1�0) 366�3 (24�7) 65 years and over � � � � � � � � � � � � � � � � � � � � � � � � � 305,670 (22,379) 30�9 (1�4) 657�8 (48�2)

65–74 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � 159,752 (10,511) 16�1 (0�7) 584�7 (38�5) 75 years and over � � � � � � � � � � � � � � � � � � � � � � � 145,918 (13,072) 14�7 (0�9) 762�3 (68�3)

Sex and age

Female � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 585,795 (30,238) 59�1 (1�0) 362�2 (18�7) Under 15 years � � � � � � � � � � � � � � � � � � � � � � � � � 58,858 (6,082) 5�9 (0�7) 197�2 (20�4) 15–24 years � � � � � � � � � � � � � � � � � � � � � � � � � � � 49,976 (6,271) 5�0 (0�6) 235�3 (29�5) 25–44 years � � � � � � � � � � � � � � � � � � � � � � � � � � � 127,017 (10,926) 12�8 (0�9) 302�7 (26�0) 45–64 years � � � � � � � � � � � � � � � � � � � � � � � � � � � 179,058 (12,897) 18�1 (0�8) 417�3 (30�1) 65–74 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � 88,254 (6,162) 8�9 (0�4) 606�7 (42�4) 75 years and over � � � � � � � � � � � � � � � � � � � � � � � 82,633 (7,390) 8�3 (0�5) 736�2 (65�8)

Male � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 405,013 (23,023) 40�9 (1�0) 262�1 (14�9) Under 15 years � � � � � � � � � � � � � � � � � � � � � � � � � 66,529 (6,461) 6�7 (0�7) 213�7 (20�8) 15–24 years � � � � � � � � � � � � � � � � � � � � � � � � � � � 25,886 (2,986) 2�6 (0�3) 119�6 (13�8) 25–44 years � � � � � � � � � � � � � � � � � � � � � � � � � � � 51,802 (4,217) 5�2 (0�4) 127�3 (10�4) 45–64 years � � � � � � � � � � � � � � � � � � � � � � � � � � � 126,014 (10,016) 12�7 (0�6) 312�1 (24�8) 65–74 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � 71,499 (5,358) 7�2 (0�4) 559�5 (41�9) 75 years and over � � � � � � � � � � � � � � � � � � � � � � � 63,284 (6,424) 6�4 (0�5) 799�2 (81�1)

��� Category not applicable� 1Visit rates are based on the July 1, 2015, set of estimates of the civilian noninstitutional population of the United States as developed by the Population Division, U�S� Census Bureau�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 5. Number of office visits per 100 persons per year by patient age and sex, in selected states: United States, 2015

Patient age Patient sex

Under 18 years 18-64 years 65 years and over Female Male Selected states (standard error) (standard error) (standard error) (standard error) (standard error)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � 203�5 (17�8) 272�8 (16�7) 657�8 (48�2) 362�2 (18�7) 262�1 (14�9)

State

Arizona � � � � � � � � � � � � � � � � � � � � � � � � � � *199�0 (75�9) 249�9 (35�3) 605�1 (139�6) 301�2 (41�2) 291�0 (42�8) California *234�2 (70�8) 318�5 (63�4) 1222�0 (353�3) 451�1 (81�4) 383�6 (82�5) Florida� � � � � � � � � � � � � � � � � � � � � � � � � � � *112�7 (65�4) 205�1 (35�2) 694�8 (142�7) 321�1 (55�2) 238�8 (43�1) Georgia� � � � � � � � � � � � � � � � � � � � � � � � � � *123�0 (49�1) 177�6 (48�0) 422�5 (109�7) 225�3 (51�0) 162�5 (38�3) Illinois *176�6 (73�6) 183�8 (32�9) 558�6 (122�2) 272�8 (46�6) 194�2 (32�3) Indiana *273�6 (82�6) 329�5 (71�7) 758�8 (164�8) 396�3 (70�3) 357�4 (81�3) Massachusetts *200�1 (113�6) *212�5 (67�5) 554�6 (130�0) 359�0 (106�2) 157�1 (27�5) Michigan � � � � � � � � � � � � � � � � � � � � � � � � � 128�3 (33�7) 210�2 (27�3) 409�4 (53�6) 243�6 (23�9) 201�4 (24�7) New Jersey � � � � � � � � � � � � � � � � � � � � � � � *338�3 (143�0) *533�0 (178�5) 854�3 (213�4) 541�2 (136�0) *531�4 (175�0) New York� � � � � � � � � � � � � � � � � � � � � � � � � *257�7 (90�4) 338�7 (65�0) 681�1 (104�3) 461�6 (85�3) 275�4 (38�3) North Carolina *151�2 (71�7) 175�4 (45�7) 449�8 (85�4) 232�7 (49�2) 187�5 (38�1) Ohio *291�8 (112�1) 219�6 (36�1) 428�3 (72�1) 323�7 (47�1) 210�5 (36�2) Pennsylvania� � � � � � � � � � � � � � � � � � � � � � *191�3 (104�5) 251�0 (43�7) 656�0 (125�7) 339�6 (53�5) 270�2 (45�9) Texas 255�8 (65�8) *337�4 (114�1) *611�0 (187�2) 442�1 (116�1) 249�6 (56�1) Virginia *185�1 (55�5) 329�7 (78�4) 861�4 (207�5) 466�9 (99�9) 271�7 (55�2) Washington� � � � � � � � � � � � � � � � � � � � � � � 189�2 (55�5) 220�1 (32�7) 666�2 (94�2) 284�0 (39�1) 270�6 (32�3)

* Figure does not meet standards of reliability or precision�

NOTES: Visit rates are based on the July 1, 2015, set of estimates of the civilian noninstritutionalized population of the United States as developed by the Population Division, U�S�Census Bureau� Numbers may not add to totals because estimates are only available for 16 states�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 6. Office visits, by patient race and age, and ethnicity: United States, 2015

Number of visits per Number of visits in thousands Percent distribution 100 persons per year1

Patient characteristic (standard error in thousands) (standard error of percent) (standard error of rate)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 (49,038) 100 ��� 313�3 (15�5)

Race and age2

White� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 769,517 (34,016) 77�7 (2�0) 315�0 (13�9) Under 15 years 94,485 (8,944) 9�5 (1�0) 213�8 (20�2) 15–24 years 57,933 (5,690) 5�8 (0�5) 183�2 (18�0) 25–44 years 139,940 (9,707) 14�1 (0�8) 224�6 (15�6) 45–64 years 234,250 (14,140) 23�6 (0�9) 351�4 (21�2) 65–74 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 125,867 (7,166) 12�7 (0�6) 547�6 (31�2) 75 years and over � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 117,043 (8,656) 11�8 (0�7) 709�9 (52�5)

Black or African American 130,562 (13,454) 13�2 (1�1) 316�4 (32�6) Under 15 years 15,688 (3,117) 1�6 (0�3) 170�8 (33�9) 15–24 years 11,717 (2,329) 1�2 (0�2) 178�3 (35�4) 25–44 years 23,762 (3,470) 2�4 (0�3) 212�2 (31�0) 45–64 years 46,064 (6,481) 4�6 (0�6) 455�8 (64�1) 65–74 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 19,447 (3,716) 2�0 (0�3) 742�9 (142�0) 75 years and over � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 13,884 (2,616) 1�4 (0�3) 873�5 (164�6)

Other3 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 90,729 (21,305) 9�2 (1�9) 295�1 (69�3)

Race, ethnicity, and age2

Hispanic or Latino� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 139,853 (14,011) 14�1 (1�2) 250�0 (25�0) Under 15 years 29,624 (4,850) 3�0 (0�5) 193�7 (31�7) 15–24 years 15,556 (3,558) 1�6 (0�3) 166�2 (38�0) 25–44 years 30,319 (4,993) 3�1 (0�5) 180�3 (29�7) 45–64 years 38,090 (6,534) 3�8 (0�6) 354�6 (60�8) 65–74 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 13,681 (2,229) 1�4 (0�2) 605�8 (98�7) 75 years and over � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 12,583 (3,455) 1�3 (0�3) 860�7 (236�4)

Not Hispanic or Latino 850,956 (43,797) 85�9 (1�2) 326�9 (16�8) White� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 640,625 (29,476) 64�7 (2�1) 328�5 (15�1)

Under 15 years 68,674 (6,884) 6�9 (0�7) 221�0 (22�2) 15–24 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 42,803 (4,034) 4�3 (0�4) 182�6 (17�2) 25–44 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 110,903 (7,252) 11�2 (0�6) 233�6 (15�3) 45–64 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 199,466 (11,976) 20�1 (0�9) 350�0 (21�0) 65–74 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 114,158 (6,739) 11�5 (0�6) 545�6 (32�2) 75 years and over 104,621 (7,067) 10�6 (0�6) 691�3 (46�7)

Black or African American� � � � � � � � � � � � � � � � � � � � � � � � � � � 126,527 (13,126) 12�8 (1�1) 327�8 (34�0) Under 15 years 14,779 (3,023) 1�5 (0�3) 176�7 (36�2) 15–24 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 11,667 (2,329) 1�2 (0�2) 191�1 (38�2) 25–44 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 23,332 (3,450) 2�4 (0�3) 224�2 (33�1) 45–64 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 43,744 (5,898) 4�4 (0�5) 452�7 (61�0) 65–74 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 19,226 (3,713) 1�9 (0�3) 760�0 (146�8) 75 years and over 13,779 (2,615) 1�4 (0�3) 896�2 (170�1)

Other3 83,804 (21,075) 8�5 (1�9) 313�7 (78�9)

��� Category not applicable� 1Visit rates are based on the July 1, 2015, set of estimates of the civilian noninstitutional population of the United States as developed by the Population Division, U�S� Census Bureau� 2The race groups white, black or African American, and other include persons of Hispanic and not of Hispanic origin� Persons of Hispanic origin may be of any race� Starting with 2009 data, the National Center for Health Statistics adopted the technique of model-based single imputation for NAMCS race and ethnicity data� The race imputation is restricted to three categories (white, black, and other) based on research by an internal work group and on quality concerns with imputed estimates for race categories other than white and black� The imputation technique is described in more detail in the 2015 National Ambulatory Medical Care Survey Public Use Data File documentation, available at: ftp://ftp�cdc�gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2015�pdf� For 2015, race data were missing for 28�6% of visits, and ethnicity data were missing for 23�4% of visits� 3Other race includes visits by Asian, Native Hawaiian or other Pacifc Islander, American Indian or Alaska Native, and persons with more than one race�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 7. Expected sources of payment at office visits: United States, 2015

Number of visits in thousands1 Percent of visits Expected source of payment (standard error in thousands) (standard error of percent)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 (49,038) ��� ���

Private insurance 552,975 (28,160) 55�8 (1�7) Medicare� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 269,578 (21,510) 27�2 (1�5) Medicaid or CHIP or other state-based program2 � � � � � � � � � � � � � � � � 156,303 (14,454) 15�8 (1�4) Medicare and Medicaid3 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 19,929 (3,053) 2�0 (0�3) No insurance4 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 51,720 (10,027) 5�2 (0�9)

Self-pay� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 47,566 (9,516) 4�8 (0�9) No charge or charity � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � *4,175 (3,222) 0�4 (0�3)

Workers’ compensation� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 6,721 (1,422) 0�7 (0�1) Other� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 16,717 (2,395) 1�7 (0�2) Unknown or blank� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 58,801 (14,368) 5�9 (1�4)

��� Category not applicable� 1Combined total of expected sources of payment exceeds “all visits” and “percent of visits” exceeds 100% because more than one source of payment may be reported per visit� 2CHIP is Children’s Health Insurance Program� 3The visits in this category are also included in both the Medicare and Medicaid or CHIP or other state-based program categories� 4“No insurance” is defned as having only self-pay, no charge, or charity as payment sources� The individual self-pay and no charge or charity categories are not mutually exclusive�

NOTE: Numbers may not add to totals because of rounding� More than one category could be indicated�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 8. Primary care provider and referral status of office visits, by prior-visit status: United States, 2015

Prior-visit status, Number of visits primary care provider, in thousands Percent distribution

and referral status (standard error in thousands) (standard error of percent)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 (49,038) 100�0 ���

Visit to PCP1 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 422,327 (37,718) 42�6 (2�6) Visit to non-PCP1,2 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 550,151 (31,436) 55�5 (2�6)

Referred for this visit � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 164,024 (13,237) 16�6 (1�2) Not referred for this visit � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 322,490 (23,181) 32�5 (2�0) Unknown if referred3 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 63,638 (6,712) 6�4 (0�7)

Unknown if PCP1 visit2,3 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 18,330 (2,501) 1�8 (0�3)

Established patient

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 829,576 (41,121) 83�7 (0�9)

Visit to PCP1 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 387,543 (33,027) 46�7 (2�6) Visit to non-PCP1,2 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 428,378 (25,550) 51�6 (2�6)

Referred for this visit � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 91,541 (10,453) 11�0 (1�2) Not referred for this visit � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 291,416 (20,861) 35�1 (2�2) Unknown if referred3 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 45,422 (5,282) 5�5 (0�6)

Unknown if PCP1 visit2,3 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 13,655 (1,985) 1�6 (0�2)

New patient

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 161,232 (12,224) 16�3 (0�9)

Visit to PCP1 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 34,785 (6,989) 21�6 (3�6) Visit to non-PCP1,2 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 121,773 (9,839) 75�5 (3�6)

Referred for this visit � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 72,483 (5,476) 45�0 (3�3) Not referred for this visit � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 31,074 (6,898) 19�3 (3�6) Unknown if referred3 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 18,216 (2,710) 11�3 (1�6)

Unknown if PCP1 visit2,3 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4,674 (1,008) 2�9 (0�7)

��� Category not applicable� 1PCP is patients primary care provider as indicated by a positive response to the question “Are you the patient’s primary care physician/provider?” 2Referral status was only asked for visits to non-PCPs and visits with unknown PCP status� Among these visits, referral information was unknown for 13�2% of visits� 3The unknown category includes blanks�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 9. Primary care provider and referral status, according to physician specialty: United States, 2015

Visit to non-PCP1,2

Referred by Not referred by Unknown if Unknown if Physician specialty Total Visit to PCP1 other physician other physician referred3 PCP1 visit2,3

Percent distribution (Standard error of percent)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 100�0 42�6 (2�6) 16�6 (1�2) 32�5 (2�0) 6�4 (0�7) 1�8 (0�3)

Pediatrics 100�0 89�4 (2�4) *2�5 (1�1) *4�7 (2�0) *2�2 (1�0) *1�2 (0�4) Internal medicine 100�0 86�6 (4�9) *5�0 (2�6) *4�3 (2�2) *1�9 (1�6) *2�3 (0�8) General and family practice 100�0 90�9 (1�8) * ��� *4�6 (1�7) 1�5 (0�4) *1�6 (0�5) Cardiovascular diseases� � � � � � � � � � � � � � � � � � � � � � � � � 100�0 *18�4 (8�0) 25�7 (4�9) 41�7 (6�3) *12�7 (5�6) *1�5 (0�6) Obstetrics and gynecology � � � � � � � � � � � � � � � � � � � � � � � 100�0 *13�4 (4�6) 12�2 (2�6) 66�2 (5�8) 5�2 (1�5) *2�9 (1�2) Psychiatry � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 100�0 *6�3 (3�4) *10�4 (3�2) 71�5 (6�9) *9�0 (3�3) *2�9 (2�0) Otolaryngology � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 100�0 *1�9 (1�1) 48�1 (5�1) 36�8 (4�6) 8�9 (2�1) *4�5 (2�3) Urology � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 100�0 *1�3 (0�5) 42�0 (4�7) 46�6 (4�9) *8�5 (3�2) *1�6 (0�9) Neurology � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 100�0 * ��� 45�0 (6�9) 46�2 (7�3) *4�5 (1�6) *3�7 (2�7) General surgery � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 100�0 *7�5 (4�1) 37�0 (4�6) 42�8 (5�7) *11�5 (3�5) * ��� Ophthalmology � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 100�0 *0�6 (0�4) 20�0 (3�7) 68�6 (4�3) 10�6 (3�0) * ��� Orthopedic surgery� � � � � � � � � � � � � � � � � � � � � � � � � � � � � 100�0 * ��� 38�0 (4�6) 42�3 (4�7) 17�6 (4�9) * ��� Dermatology � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 100�0 * ��� 20�1 (3�7) 55�1 (5�1) 21�3 (4�3) *3�4 (1�9) All other specialties� � � � � � � � � � � � � � � � � � � � � � � � � � � � � 100�0 *10�6 (4�0) 31�4 (4�9) 49�5 (5�4) 7�1 (1�5) *1�3 (0�6)

��� Category not applicable� * Figure does not meet standards of reliability or precision� 1PCP is patient’s primary care provider as indicated by a positive response to the question “Are you the patient’s primary care physician/provider?” 2Referral status was asked only for visits to non-PCPs and visits with unknown PCP status� Among these visits, referral information was unknown for 13�2% of visits� 3The unknown category includes blanks�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 10. Continuity-of-care office visit characteristics, by specialty type: United States, 2015

Specialty type1 Specialty type1

Continuity-of-care visit characteristic All specialties Primary care Surgical specialties Medical specialties All specialties Primary care Surgical specialties Medical specialties

Number of visits in thousands (standard error in thousands) Percent distribution (standard error of percent)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 (49,038) 505,522 (38,066) 203,856 (13,179) 281,430 (32,708) 100�0 ��� 100�0 ��� 100�0 ��� 100�0 ���

Prior-visit status and number of visits in last 12 months

Established patient2 � � � � � � � � � � � � � � � � � � � � � � � � � � � None � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1–2 visits � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 3–5 visits � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 6 or more visits � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

New patient� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

829,750 (41,138) 59,643 (3,758)

294,966 (18,059) 264,706 (17,551) 210,435 (13,792) 161,059 (12,223)

448,906 (32,534) 29,611 (3,088)

148,835 (15,603) 144,193 (12,317) 126,267 (11,792) 56,616 (7,958)

155,262 (10,636) 16,817 (1,601) 64,477 (4,200) 44,951 (3,553) 29,017 (3,555) 48,594 (4,070)

225,582 (26,677) 13,215 (1,689) 81,654 (9,230) 75,562 (12,861) 55,151 (7,233) 55,848 (8,995)

83�7 (0�9) 6�0 (0�4)

29�8 (1�0) 26�7 (0�9) 21�2 (1�1) 16�3 (0�9)

88�8 (1�1) 5�9 (0�6)

29�4 (1�7) 28�5 (1�4) 25�0 (1�9) 11�2 (1�1)

76�2 (1�4) 8�2 (0�6)

31�6 (1�1) 22�1 (0�8) 14�2 (1�3) 23�8 (1�4)

80�2 (2�1) 4�7 (0�6)

29�0 (1�6) 26�8 (2�1) 19�6 (1�8) 19�8 (2�1)

��� Category not applicable� 1Specialty types are defned in the 2015 public use fle documentation, available at: ftp://ftp�cdc�gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2015�pdf� 2Number of previous visits by established patients to responding physician in the last 12 months�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 11. Twenty leading principal reasons for office visits, by patient’s sex: United States, 2015

Female2 Male3

Number of visits in thousands1 Percent distribution Percent distribution Percent distribution Principal reason for visit and RVC code1 (standard error in thousands) (standard error of percent) (standard error of percent) (standard error of percent)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 (49,038) 100�0 ��� 100�0 ��� 100�0 ���

Progress visit, not otherwise specifed � � � � � � � � � � � � � � � � � � � � � � � � � � T800 140,842 (12,765) 14�2 (1�2) 13�6 (1�2) 15�1 (1�4) General medical examination � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � X100 75,412 (6,690) 7�6 (0�6) 6�9 (0�6) 8�6 (0�8) Medication, other and unspecifed kinds � � � � � � � � � � � � � � � � � � � � � � � � T115 35,232 (7,003) 3�6 (0�6) 2�9 (0�5) 4�5 (0�9) Counseling, not otherwise specifed � � � � � � � � � � � � � � � � � � � � � � � � � � � � T605 26,528 (5,495) 2�7 (0�5) 2�8 (0�6) 2�5 (0�4) Postoperative visit� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � T205 25,441 (2,679) 2�6 (0�3) 2�7 (0�3) 2�4 (0�3) Cough � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � S440 20,984 (2,718) 2�1 (0�3) 1�9 (0�3) 2�4 (0�5) Gynecological examination� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � X225 20,735 (4,607) 2�1 (0�4) 3�5 (0�7) ��� ��� Prenatal examination, routine � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � X205 18,152 (4,460) 1�8 (0�5) 3�1 (0�7) ��� ��� Knee symptoms � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � S925 16,241 (2,629) 1�6 (0�3) 1�7 (0�3) 1�6 (0�3) Back symptoms � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � S905 15,875 (3,701) 1�6 (0�4) 1�5 (0�4) 1�7 (0�5) Hypertension � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � D510 *15,762 (4,820) 1�6 (0�5) 1�2 (0�2) *2�2 (1�1) For other and unspecifed test results� � � � � � � � � � � � � � � � � � � � � � � � � � � R700 15,159 (3,625) 1�5 (0�3) 1�6 (0�4) 1�4 (0�4) Stomach and abdominal pain, cramps and spasms� � � � � � � � � � � � � � � � S545 15,026 (2,796) 1�5 (0�3) 1�9 (0�4) 1�0 (0�2) Well baby examination � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � X105 13,217 (2,019) 1�3 (0�2) 0�9 (0�2) 1�9 (0�3) Shoulder symptoms � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � S940 *12,619 (4,604) *1�3 (0�4) *1�1 (0�4) *1�6 (0�5) Diabetes mellitus � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � D205 12,432 (2,608) 1�3 (0�3) 1�1 (0�3) 1�5 (0�4) Skin rash� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � S860 9,464 (1,373) 1�0 (0�1) 0�7 (0�1) 1�3 (0�3) Preoperative visit for specifed and unspecifed types of surgery � � � � � � T200 9,443 (1,424) 1�0 (0�1) 0�9 (0�2) 1�1 (0�2) Symptoms referable to throat � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � S455 9,346 (2,021) 0�9 (0�2) 1�0 (0�2) 0�8 (0�2) Other special examination � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � X240 9,092 (1,473) 0�9 (0�2) 0�9 (0�2) 0�9 (0�2)

All other reasons� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 473,807 (24,570) 47�8 (1�2) 48�0 (1�3) 47�5 (1�5)

���Category not applicable� *Figure does not meet standards of reliability or precision� 1Based on A Reason for Visit Classifcation for Ambulatory Care (RVC), defned in the 2015 public use fle documentation (ftp://ftp�cdc�gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2015�pdf)� 2Based on 585,795,000 visits made by females� 3Based on 405,013,000 visits made by males�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 12. Provider-assessed major reason for office visit, by selected patient and visit characteristics: United States, 2015

Total number of visits in thousands (standard error in Chronic problem, Chronic problem,

Patient and visit characteristic thousands) Total percent New problem routine fare-up Pre-surgery Post-surgery Preventive care1 Unknown or blank

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 (49,038) 100�0 30�9 (1�1) 33�3 (1�5) 7�0 (0�6) 1�5 (0�2) 4�6 (0�5) 20�4 (1�2) 2�3 (0�6)

Age

Under 15 years � � � � � � � � � � � � � � � � � � � � � � � � � 125,386 (11,829) 100�0 48�8 (2�1) 10�9 (1�7) 2�8 (0�5) * ��� 1�2 (0�2) 33�8 (2�0) *2�2 (0�8) Under 1 year � � � � � � � � � � � � � � � � � � � � � � � � � 24,522 (3,554) 100�0 35�7 (3�2) * ��� * ��� * ��� * ��� 53�7 (3�3) * ��� 1–4 years � � � � � � � � � � � � � � � � � � � � � � � � � � � 38,205 (4,271) 100�0 55�2 (2�5) 5�8 (1�4) *1�9 (0�7) * ��� 1�3 (0�3) 34�2 (2�4) *1�5 (0�5) 5–14 years � � � � � � � � � � � � � � � � � � � � � � � � � � 62,660 (5,758) 100�0 50�1 (2�8) 16�8 (2�4) 4�0 (0�7) * ��� 1�3 (0�3) 25�8 (2�3) * ���

15–24 years � � � � � � � � � � � � � � � � � � � � � � � � � � � 75,861 (7,688) 100�0 35�2 (2�9) 21�4 (3�2) 4�9 (1�1) * ��� 3�5 (1�0) 32�2 (4�3) *1�6 (0�6) 25–44 years � � � � � � � � � � � � � � � � � � � � � � � � � � � 178,819 (12,919) 100�0 30�9 (1�8) 26�0 (1�8) 6�9 (0�8) 1�4 (0�3) 4�8 (0�6) 27�5 (2�5) 2�5 (0�7) 45–64 years � � � � � � � � � � � � � � � � � � � � � � � � � � � 305,071 (20,537) 100�0 29�0 (1�7) 37�6 (1�9) 9�3 (1�1) 1�6 (0�3) 6�0 (0�9) 14�0 (1�4) *2�4 (0�9) 65 years and over � � � � � � � � � � � � � � � � � � � � � � � 305,670 (22,379) 100�0 24�2 (1�4) 45�3 (2�3) 7�0 (0�8) 2�2 (0�4) 4�7 (0�5) 14�2 (1�4) *2�4 (0�8)

65–74 years� � � � � � � � � � � � � � � � � � � � � � � � � � 159,752 (10,511) 100�0 24�1 (1�4) 41�0 (2�3) 7�9 (1�1) 2�4 (0�5) 5�4 (0�6) 17�0 (1�9) *2�1 (0�7) 75 years and over � � � � � � � � � � � � � � � � � � � � � 145,918 (13,072) 100�0 24�4 (2�2) 50�1 (2�9) 6�0 (0�8) 1�8 (0�5) 4�0 (0�5) 11�1 (1�4) *2�7 (1�0)

Sex

Female � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 585,795 (30,238) 100�0 31�2 (1�2) 30�1 (1�7) 7�4 (0�8) 1�4 (0�2) 4�4 (0�5) 23�1 (1�7) 2�3 (0�7) Male � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 405,013 (23,023) 100�0 30�4 (1�4) 37�9 (1�8) 6�4 (0�5) 1�7 (0�3) 4�8 (0�6) 16�6 (1�0) 2�3 (0�7)

Race2

White� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 769,517 (34,016) 100�0 30�3 (1�1) 33�4 (1�5) 7�1 (0�5) 1�6 (0�2) 5�1 (0�5) 20�0 (1�1) 2�4 (0�7) Black or African American � � � � � � � � � � � � � � � � 130,562 (13,454) 100�0 29�8 (2�3) 31�9 (2�9) 7�5 (1�8) 1�6 (0�5) 3�2 (0�7) 22�9 (2�9) *3�0 (1�0) Other3 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 90,729 (21,305) 100�0 36�7 (2�5) 34�2 (5�6) 5�3 (1�5) * ��� *1�7 (0�6) 20�0 (4�3) * ���

Race and ethnicity2

Hispanic or Latino� � � � � � � � � � � � � � � � � � � � � � � 139,853 (14,011) 100�0 35�6 (3�1) 17�7 (2�0) 6�9 (1�3) *1�6 (0�5) 5�8 (1�7) 26�2 (3�5) *6�2 (3�4) Not Hispanic or Latino � � � � � � � � � � � � � � � � � � � 850,956 (43,797) 100�0 30�1 (1�2) 35�8 (1�6) 7�0 (0�6) 1�5 (0�2) 4�4 (0�4) 19�5 (1�1) 1�7 (0�3)

White� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 640,625 (29,476) 100�0 29�5 (1�2) 36�4 (1�6) 7�2 (0�6) 1�6 (0�2) 5�0 (0�4) 18�7 (1�0) 1�6 (0�3) Black or African American� � � � � � � � � � � � � � � 126,527 (13,126) 100�0 29�4 (2�3) 32�6 (2�9) 7�2 (1�6) 1�5 (0�4) 3�2 (0�7) 23�1 (2�9) *3�0 (1�0) Other3 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 83,804 (21,075) 100�0 35�6 (2�6) 36�2 (5�6) *5�4 (1�7) * ��� *1�5 (0�5) 19�9 (4�6) * ���

Expected source(s) of payment4

Private insurance 552,975 (28,160) 100�0 32�3 (1�2) 31�1 (1�4) 7�5 (0�8) 1�7 (0�3) 5�2 (0�6) 20�7 (1�1) 1�5 (0�3) Medicare� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 269,578 (21,510) 100�0 24�3 (1�4) 45�6 (2�6) 7�3 (0�9) 2�2 (0�4) 4�4 (0�5) 13�5 (1�7) *2�7 (1�0) Medicare and Medicaid5 � � � � � � � � � � � � � � � � � � 19,929 (3,053) 100�0 25�7 (4�6) 40�8 (5�9) *9�1 (2�9) * ��� 2�9 (0�7) 8�0 (2�1) * ��� Medicaid or CHIP or other

state-based program6 � � � � � � � � � � � � � � � � � � � 156,303 (14,454) 100�0 36�0 (2�6) 20�3 (2�2) 6�4 (1�1) 0�9 (0�2) 3�2 (0�6) 28�7 (3�7) *4�6 (2�4) No insurance7 � � � � � � � � � � � � � � � � � � � � � � � � � � 51,720 (10,027) 100�0 33�0 (4�5) 43�6 (4�9) 6�5 (1�5) * ��� *3�5 (1�1) 10�1 (2�4) * ��� Other8 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 47,959 (4,740) 100�0 26�0 (2�4) 37�0 (3�5) 8�6 (1�6) * ��� 7�1 (1�0) 17�6 (2�8) * ���

* Figure does not meet standards of reliability or precision� … Category not applicable� 1Preventive care includes routine prenatal, well-baby, screening and insurance, or general exams (see major reason for visit question on the Patient Record Sample Card at https://www�cdc�gov/nchs/data/ahcd/2015_NAMCS_PRF_Sample_Card�pdf)� 2The race groups white, black or African American, and other include persons of Hispanic and not of Hispanic origin� Persons of Hispanic origin may be of any race� Starting with 2009 data, the National Center for Health Statistics adopted the technique of model-based single imputation for NAMCS race and ethnicity data� The race imputation is restricted to three categories (white, black, and other) based on research by an internal work group and on quality concerns with imputed estimates for race categories other than white and black� The imputation technique is described in more detail in the 2015 National Ambulatory Medical Care Survey Public Use Data fle documentation, available at: ftp://ftp�cdc�gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2015�pdf� For 2015, race data were missing for 28�6% of visits, and ethnicity data were missing for 23�4% of visits� 3Other race includes visits by Asian, Native Hawaiian or other Pacifc Islander, American Indian or Alaska Native, and persons with more than one race� 4Combined total of individual sources exceeds “all visits” and percent of visits exceeds 100% because more than one source of payment may be reported per visit� 5The visits in this category are also included in both the Medicaid or CHIP or other state-based program and Medicare categories� 6CHIP is Children’s Health Insurance Program� 7No insurance is defned as having only self-pay, no charge, or charity as payment sources� 8Other includes workers’ compensation, unknown or blank, and sources not classifed elsewhere�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 13. Preventive care visits made to primary care specialists, by selected patient and visit characteristics: United States, 2015

Percent of preventive care Number of visits Number of visits per 100 visits made to

in thousands Percent distribution persons per year1 primary care specialists2

Patient and visit characteristics (standard error in thousands) (standard error of percent) (standard error of rate) (standard error of percent)

All preventive care visits3 202,266 (14,826) 100�0 ��� 64�0 (4�7) 82�9 (2�2)

Age

Under 15 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 42,358 (4,965) 20�9 (2�8) 69�5 (8�1) 93�6 (2�9) Under 1 year � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 13,157 (1,992) 6�5 (1�1) 330�9 (50�1) 96�3 (1�9) 1–4 years 13,048 (1,712) 6�5 (0�9) 81�9 (10�8) 94�2 (3�5) 5–14 years 16,153 (2,072) 8�0 (1�1) 39�3 (5�0) 90�9 (3�5)

15–24 years 24,445 (4,791) 12�1 (1�9) 57�0 (11�2) 91�1 (3�3) 25–44 years 49,247 (6,592) 24�3 (2�3) 59�6 (8�0) 91�9 (1�9) 45–64 years 42,743 (5,205) 21�1 (1�9) 51�3 (6�2) 77�4 (4�0) 65 years and over � � � � � � � � � � � � � � � � � � � � � � � � � � � 43,473 (5,738) 21�5 (2�5) 93�6 (12�3) 63�3 (5�6)

65–74 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 27,209 (3,867) 13�5 (1�7) 99�6 (14�2) 66�7 (5�6) 75 years and over � � � � � � � � � � � � � � � � � � � � � � � � � 16,264 (2,234) 8�0 (1�0) 85�0 (11�7) 57�7 (6�4)

Sex and age

Female 135,131 (12,483) 66�8 (2�3) 83�6 (7�7) 87�1 (2�0) Under 15 years 19,809 (2,470) 9�8 (1�4) 66�4 (8�3) 93�4 (2�6) 15–24 years 20,945 (4,734) 10�4 (1�9) 98�6 (22�3) 95�5 (1�6) 25–44 years 43,256 (6,499) 21�4 (2�4) 103�1 (15�5) 94�6 (1�5) 45–64 years 25,502 (3,094) 12�6 (1�2) 59�4 (7�2) 80�5 (3�8) 65–74 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 15,177 (2,717) 7�5 (1�2) 104�3 (18�7) 70�6 (6�6) 75 years and over � � � � � � � � � � � � � � � � � � � � � � � � � 10,442 (1,854) 5�2 (0�8) 93�0 (16�5) 67�3 (7�0)

Male 67,134 (5,205) 33�2 (2�3) 43�4 (3�4) 74�6 (3�2) Under 15 years 22,549 (2,907) 11�1 (1�6) 72�4 (9�3) 93�8 (3�3) 15–24 years 3,499 (967) 1�7 (0�5) 16�2 (4�5) 65�1 (14�8) 25–44 years 5,991 (914) 3�0 (0�5) 14�7 (2�2) 72�2 (6�1) 45–64 years 17,241 (2,844) 8�5 (1�1) 42�7 (7�0) 72�7 (5�6) 65–74 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 12,032 (1,748) 5�9 (0�8) 94�2 (13�7) 61�8 (6�7) 75 years and over � � � � � � � � � � � � � � � � � � � � � � � � � 5,822 (906) 2�9 (0�5) 73�5 (11�4) 40�4 (8�0)

Race4

White� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 154,164 (10,191) 76�2 (2�4) 63�1 (4�2) 80�4 (2�3) Black or African American 29,961 (5,362) 14�8 (2�0) 72�6 (13�0) 90�1 (3�4) Other5 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 18,141 (3,064) 9�0 (1�3) 59�0 (10�0) 92�9 (3�3)

Ethnicity4

Hispanic or Latino� � � � � � � � � � � � � � � � � � � � � � � � � � � 36,649 (6,589) 18�1 (2�6) 65�5 (11�8) 92�6 (2�2) Not Hispanic or Latino 165,616 (11,924) 81�9 (2�6) 63�6 (4�6) 80�8 (2�5)

White� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 119,800 (7,601) 59�2 (3�3) 61�4 (3�9) 76�9 (2�6) Black or African American� � � � � � � � � � � � � � � � � � � 29,173 (5,363) 14�4 (2�0) 75�6 (13�9) 89�9 (3�5) Other5 16,644 (3,035) 8�2 (1�3) 62�3 (11�4) 92�7 (3�5)

Expected source(s) of payment6

Private insurance 114,208 (8,039) 56�5 (3�1) 58�0 (4�1) 81�6 (2�5) Medicare� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 36,292 (6,103) 17�9 (2�7) 72�2 (12�1) 66�1 (6�6) Medicaid or CHIP or other

state-based program7 � � � � � � � � � � � � � � � � � � � � � � � 44,878 (8,157) 22�2 (3�5) 80�7 (14�7) 94�3 (2�0) Medicare and Medicaid 1,595 (411) 0�8 (0�2) ��� ��� * ��� No insurance8 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5,208 (1,033) 2�6 (0�5) 18�2 (3�6) 67�1 (10�3) Other9 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 8,441 (1,649) 4�2 (0�8) ��� ��� 82�4 (5�8)

* Figure does not meet standards of reliability or precision� ��� Category not applicable� 1Visit rates for age, sex, and race and ethnicity are based on the July 1, 2015, set of estimates of the civilian noninstitutional population of the United States as developed by the Population Division, U�S� Census Bureau� Visit rates for expected source(s) of payment are based on the 2015 National Health Interview Survey estimates of health insurance� 2Primary care specialty as defned in the 2015 public use fle documentation (ftp://ftp�cdc�gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2015�pdf)� 3Preventive care includes routine prenatal, well-baby, screening, insurance or general exams (see “Major reason for this visit” question on the Patient Record Sample card, available at: https://www�cdc�gov/nchs/data/ahcd/2015_NAMCS_PRF_Sample_Card�pdf)� 4The race groups white, black or African American, and other include persons of Hispanic and not of Hispanic origin� Persons of Hispanic origin may be of any race� Starting with 2009 data, the National Center for Health Statistics adopted the technique of model-based single imputation for NAMCS race and ethnicity data� The race imputation is restricted to three categories (white, black, and other) based on research by an internal work group and on quality concerns with imputed estimates for race categories other than white and black� The imputation technique is described in more detail in the 2015 National Ambulatory Medical Care Survey Public Use Data fle documentation, available at: ftp://ftp�cdc�gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2015�pdf� For 2015, race data were missing for 31�7% of preventive care visits, and ethnicity data were missing for 24�8% of preventive care visits� 5Other includes visits by Asian, Native Hawaiian or other Pacifc Islander, American Indian or Alaska Native, and persons with more than one race� 6Combined total of individual sources exceeds all visits and percent of visits exceeds 100% because more than one source of payment may be reported per visit� 7CHIP is Children’s Health Insurance Program� 8No insurance is defned as having only self-pay, no charge or charity as payment sources� The visit rate was calculated using uninsured as the denominator from the 2015 estimates of health insurance coverage from the National Health Interview Survey� 9Other includes workers’ compensation, unknown or blank, and sources not classifed elsewhere�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 14. Preventive care visits made to primary care specialists, by selected states: United States, 2015

Selected states Number of visits in thousands (standard error in thousands)

Number of visits per 100 persons per year1 (standard error of rate)

Percent of preventive care visits made to primary care specialists2

(standard error of percent)

All preventive care visits3 � � � � � � � � � � � � 202,266 (14,826) 64�0 (4�7) 82�9 (2�2)

State

Arizona � � � � � � � � � � � � � � � � � � � � � � � � � � California � � � � � � � � � � � � � � � � � � � � � � � � Florida� � � � � � � � � � � � � � � � � � � � � � � � � � � Georgia� � � � � � � � � � � � � � � � � � � � � � � � � � Illinois � � � � � � � � � � � � � � � � � � � � � � � � � � � Indiana � � � � � � � � � � � � � � � � � � � � � � � � � � Massachusetts � � � � � � � � � � � � � � � � � � � � Michigan � � � � � � � � � � � � � � � � � � � � � � � � � New Jersey � � � � � � � � � � � � � � � � � � � � � � � New York� � � � � � � � � � � � � � � � � � � � � � � � � North Carolina � � � � � � � � � � � � � � � � � � � � Ohio � � � � � � � � � � � � � � � � � � � � � � � � � � � � Pennsylvania� � � � � � � � � � � � � � � � � � � � � � Texas � � � � � � � � � � � � � � � � � � � � � � � � � � � Virginia � � � � � � � � � � � � � � � � � � � � � � � � � � Washington� � � � � � � � � � � � � � � � � � � � � � �

3,059 29,139

7,882 3,027 7,515 4,678

*3,264 3,351

*4,326 7,941

*3,406 6,407

*5,475 *21,884

4,212 2,205

(833) (6,703) (2,096)

(821) (2,140) (1,186) (1,654)

(672) (2,002) (1,916) (1,287) (1,405) (1,676) (8,851) (1,066)

(400)

45�5 (12�4) 75�5 (17�4) 39�5 (10�5) 30�2 (8�2) 59�3 (16�9) 71�7 (18�2)

*48�6 (24�6) 34�2 (6�9)

*48�9 (22�6) 40�6 (9�8)

*34�7 (13�1) 56�0 (12�3)

*43�5 (13�3) *81�1 (32�8) 51�5 (13�0) 31�2 (5�7)

62�7 (12�8) 88�6 (5�4) 75�3 (8�7)

*47�7 (21�5) 85�5 (5�1) 83�5 (6�4) 80�5 (14�1) 91�9 (5�2) 52�5 (15�5) 74�9 (11�2) 71�7 (14�1) 87�7 (4�6) 79�1 (7�0) 97�6 (1�2) 88�2 (4�4) 92�2 (2�7)

* Figure does not meet standards of reliability or precision� 1Visit rates are based on the July 1, 2015, set of estimates of the civilian noninstitutionalized population of the United States as developed by the Population Division, U�S� Census Bureau� 2Primary care specialty as defned in the 2015 public use fle documentation (ftp://ftp�cdc�gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2015�pdf)� 3Preventive care includes routine prenatal, well-baby, screening, insurance or general exams (see Major reason for this visit question on the Patient Record Sample Card, available from http://www�cdc�gov/nchs/data/ahcd/2015_NAMCS_PRF_Sample_card�pdf)�

NOTE: Numbers do not add to total because estimates are only available for 16 states�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 15. Primary diagnosis at office visits, classifed by major disease category: United States, 2015

Number of visits in thousands Percent distribution Major disease category and ICD-9-CM code range1 (standard error in thousands) (standard error of percent)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 (49,038) 100�0 ���

Infectious and parasitic diseases 001–139 16,794 (2,027) 1�7 (0�2) Neoplasms 140–239 37,075 (6,205) 3�7 (0�6) Endocrine, nutritional, metabolic diseases, and immunity disorders 240–279 69,845 (10,227) 7�0 (0�9) Mental disorders � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �290–319 59,776 (8,211) 6�0 (0�8) Diseases of the nervous system and sense organs � � � � � � � � � � � � � � � � � � � � � � � � � � � �320–389 89,562 (6,596) 9�0 (0�7) Diseases of the circulatory system � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �390–459 88,343 (10,475) 8�9 (0�9) Diseases of the respiratory system� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �460–519 64,624 (6,269) 6�5 (0�5) Diseases of the digestive system � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �520–579 32,271 (5,976) 3�3 (0�6) Diseases of the genitourinary system� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �580–629 45,388 (4,399) 4�6 (0�4) Diseases of the skin and subcutanaous tissue� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �680–709 44,576 (4,672) 4�5 (0�5) Diseases of the musculoskeletal and connective tissue� � � � � � � � � � � � � � � � � � � � � � � � �710–739 108,700 (17,702) 11�0 (1�5) Symptoms, signs, and ill-defned conditions� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �780–799 73,149 (6,519) 7�4 (0�5) Injury and poisoning � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �800–999 31,659 (3,848) 3�2 (0�4) Supplementary classifcation2� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �V01–V90 198,910 (13,104) 20�1 (1�1) All other diagnoses3 ��� 26,802 (3,919) 2�7 (0�4) Blank� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � ��� 3,333 (738) 0�3 (0�1)

��� Category not applicable� 1Based on the International Classifcation of Diseases, Ninth Revision, Clinical Modifcation (ICD–9–CM) (U�S� Department of Health and Human Services, Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services� Official version: International Classifcation of Diseases, Ninth Revision, Clinical Modifcation, Sixth Edition� DHHS Pub No� (PHS) 11–1260)� 2Supplementary classifcation is preventive and follow-up care and includes general medical examination, routine prenatal examination, and health supervision of an infant or child, and other diagnoses not classifable to injury or illness� 3Includes diseases of the blood and blood-forming organs (280–289); complications of pregnancy, childbirth, and the puerperium (630–677); congenital anomalies (740–759); certain conditions originating in perinatal period (760–779); and entries not codable to the ICD–9–CM (e�g� “illegible entries, left against medical advice, transferred, entries of none, or no diagnoses)�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 16. Twenty leading primary diagnosis groups for office visits: United States, 2015

Number of visits in thousands (standard error in Percent distribution Female2 percent distribution Male3 percent distribution

Primary diagnosis group and ICD-9-CM code(s)1 thousands) (standard error of percent) (standard error of percent) (standard error of percent)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 (49,038) 100�0 ��� 100�0 ��� 100�0 ���

Arthropathies and related disorders � � � � � � � � � � � � � � � � � � � � � � 710–719 46,997 (9,732) 4�7 (0�9) 4�7 (1�1) 4�8 (0�8) Essential hypertension � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 401 42,749 (5,982) 4�3 (0�5) 3�6 (0�5) 5�4 (0�9) Spinal disorders 720–724 37,833 (7,164) 3�8 (0�6) 3�4 (0�6) 4�4 (0�9) Routine infant or child health check V20�0–V20�2 37,473 (4,371) 3�8 (0�5) 3�1 (0�4) 4�7 (0�6) Diabetes mellitus 249–250 34,593 (4,971) 3�5 (0�5) 2�7 (0�4) 4�7 (0�7) General medical examination � � � � � � � � � � � � � � � � � � � � � � � � � � � V70 32,078 (5,029) 3�2 (0�4) 3�0 (0�5) 3�6 (0�6) Acute upper respiratory infections, excluding pharyngitis� � � � � � 460–461,463–466 25,162 (3,204) 2�5 (0�3) 2�8 (0�4) 2�2 (0�4) Malignant neoplasms 140–208,209–209�36,209�7–209�79,230–234 24,601 (5,887) 2�5 (0�6) 2�3 (0�6) 2�8 (0�6) Specifc procedures and aftercare V50–V59�9 23,591 (4,681) 2�4 (0�5) 2�2 (0�4) 2�6 (0�6) Rheumatism, excluding back 725–729 20,864 (5,302) 2�1 (0�5) 2�3 (0�6) 1�9 (0�4) Gynecological examination� � � � � � � � � � � � � � � � � � � � � � � � � � � � � V72�3 18,171 (4,469) 1�8 (0�4) 3�1 (0�7) ��� ��� Heart disease, excluding ischemic � � � � � � � � � � � � � � � � � � � � � � � 391–392�0,393–398,402,404,415–416, 15,486 (2,488) 1�6 (0�3) 1�3 (0�3) 1�9 (0�4)

420–429 Disorders of lipoid metabolism 272 14,474 (2,973) 1�5 (0�3) 1�3 (0�3) 1�7 (0�4) Normal pregnancy V22 14,324 (2,945) 1�4 (0�3) 2�4 (0�5) ��� ��� Benign neoplasms 210–229,209�4–209�69,235–239 12,474 (1,628) 1�3 (0�2) 1�1 (0�2) 1�4 (0�2) Ischemic heart disease� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 410–414�9 11,594 (2,599) 1�2 (0�3) 0�7 (0�2) 1�9 (0�5) Attention defcit disorder � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 314 11,457 (2,436) 1�2 (0�2) 0�9 (0�2) 1�6 (0�4) Anxiety states � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 300 10,943 (1,814) 1�1 (0�2) 1�1 (0�2) 1�2 (0�2) Psychoses, excluding major depressive disorder 290–295,296�0-296�1,296�4–299 10,710 (1,954) 1�1 (0�2) 1�1 (0�2) 1�1 (0�2) Follow up examination V67 9,941 (1,740) 1�0 (0�2) 0�9 (0�2) 1�1 (0�3) All other diagnoses4 535,293 (25,194) 54�0 (1�4) 56�1 (1�5) 51�0 (1�7)

��� Category not applicable� 1Based on the International Classifcation of Diseases, Ninth Revision, Clinical Modifcation (ICD–9–CM) (U�S� Department of Health and Human Services, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services� Official version: International Classifcation of Diseases, Ninth Revision, Clinical Modifcation, Sixth Edition� DHHS Pub No� (PHS) 11–1260)� However, certain codes have been combined in this table to form larger categories that better describe the utilization of ambulatory care services� 2Based on 585,795,000 visits made by females� 3Based on 405,013,000 visits made by males� 4Includes all other diagnoses not listed above, as well as unknown and blank diagnoses�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 17. Injury visits to office-based physicians, by selected patient and visit characteristics: United States, 2015

Patient characteristics Number of visits in thousands (standard error in thousands)

Percent distribution (standard error of percent)

Number of visits per 100 persons per year1 (standard error of rate)

All injury visits2 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 82,358 (7,503) 100�0 ��� 26�0 (2�4)

Age

Under 15 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Under 1 year � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1–4 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5–14 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

15–24 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 25–44 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 45–64 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 65 years and over � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

65–74 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 75 years and over � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

8,720 (1,738) * ���

1,861 (416) 6,694 (1,639) 9,049 (2,313)

13,247 (1,601) 24,986 (2,459) 26,355 (2,640) 14,421 (1,715) 11,934 (1,449)

10�6 (1�7) * ���

2�3 (0�5) 8�1 (1�6)

11�0 (2�1) 16�1 (1�6) 30�3 (1�8) 32�0 (2�5) 17�5 (1�7) 14�5 (1�6)

14�3 (2�8) * ���

11�7 (2�6) 16�3 (4�0) 21�1 (5�4) 16�0 (1�9) 30�0 (3�0) 56�7 (5�7) 52�8 (6�3) 62�3 (7�6)

Sex and age

Female � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Under 15 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 15–24 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 25–44 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 45–64 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 65–74 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 75 years and over � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

42,267 (4,598) 4,446 (1,220)

*4,398 (1,434) 5,716 (934)

12,679 (1,490) 7,943 (1,187) 7,084 (1,179)

51�3 (1�8) 5�4 (1�2) 5�3 (1�5) 6�9 (1�0)

15�4 (1�3) 9�6 (1�2) 8�6 (1�3)

26�1 (2�8) 14�9 (4�1)

*20�7 (6�7) 13�6 (2�2) 29�5 (3�5) 54�6 (8�2) 63�1 (10�5)

Male � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Under 15 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 15–24 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 25–44 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 45–64 years � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 65–74 years� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 75 years and over � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

40,091 (3,396) 4,273 (739) 4,651 (1,102) 7,531 (1,073)

12,307 (1,274) 6,478 (1,044) 4,850 (684)

48�7 (1�8) 5�2 (0�8) 5�6 (1�0) 9�1 (1�2)

14�9 (1�1) 7�9 (1�2) 5�9 (0�8)

25�9 13�7 21�5 18�5 30�5 50�7 61�3

(2�2) (2�4) (5�1) (2�6) (3�2) (8�2) (8�6)

Race3

White� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Black or African American � � � � � � � � � � � � � � � � � � � � � � � � � � Other4 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

68,083 (6,456) 6,898 (954)

*7,376 (2,932)

82�7 (3�2) 8�4 (1�2)

*9�0 (3�3)

27�9 16�7

*24�0

(2�6) (2�3) (9�5)

Race and ethnicity3

Hispanic or Latino� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Not Hispanic or Latino � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

White� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Black or African American� � � � � � � � � � � � � � � � � � � � � � � � � Other4 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

8,271 (1,370) 74,087 (6,972) 61,272 (5,899) 6,554 (924)

*6,261 (2,843)

10�0 (1�5) 90�0 (1�5) 74�4 (3�1) 8�0 (1�1)

*7�6 (3�2)

14�8 (2�4) 28�5 (2�7) 31�4 (3�0) 17�0 (2�4)

*23�4 (10�6)

* Figure does not meet standards of reliability or precision� ��� Category not applicable� 1Visit rates for age, sex, race, and ethnicity are based on the July 1, 2015, set of estimates of the civilian noninstitutional population of the United States as developed by the Population Division, U�S� Census Bureau� 2The National Ambulatory Medical Care Survey defnition of injury visits, as shown in this table, changed in 2010 and includes only frst-, second-, third-, fourth-, and ffth-listed reason for visit and diagnosis codes that are injury or poisoning related� Adverse effects and complications are excluded� Reason for visit was coded using A Reason for Visit Classifcation for Ambulatory Care; diagnosis was coded using the International Classifcation of Diseases, Ninth Revision, Clinical Modifcation (ICD–9–CM) (U�S� Department of Health and Human Services, Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services� Official version: International Classifcation of Diseases, Ninth Revision, Clinical Modifcation, Sixth Edition� DHHS Pub No� (PHS) 11–1260)� Injury visits, using this defnition, accounted for 8�3% (SE = 0�7) of all office visits in 2015� For more information on why this defnition changed, see the 2015 National Ambulatory Medical Care Survey Public Use Data File Documentation, available at: http://ftp�cdc�gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2015�pdf� 3The race groups white, black or African American, and other include persons of Hispanic and not of Hispanic origin� Persons of Hispanic origin may be of any race� Starting with 2009 data, the National Center for Health Statistics adopted the technique of model-based single imputation for NAMCS race and ethnicity data� The race imputation is restricted to three categories (white, black, and other) based on research by an internal work group and on quality concerns with imputed estimates for race categories other than white and black� The imputation technique is described in more detail in the 2015 National Ambulatory Medical Care Survey Public Use Data File documentation, available at: ftp://ftp�cdc�gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2015�pdf� For 2015, race data were missing for 26�7% of injury visits, and ethnicity data were missing for 25�5% of injury visits� 4Other race includes visits by Asian, Native Hawaiian or other Pacifc Islander, American Indian or Alaska Native, and persons with more than one race�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 18. Office visits related to injury or trauma, overdose or poisoning, and adverse effects, by intent and mechanism: United States, 2015

Intent1, mechanism2 , Number of visits in thousands Percent distribution and cause-of-injury code2 (standard error in thousands) (standard error of percent)

All visits related to injury, poisoning, and adverse effect1 � � � � � � � � � � � � � � � � � � � � � � � � � � � … 92,217 (7,842) 100�0 ���

Unintentional injury or poisoning1 � � � � � � � � � � � � � � � � � … 56,843 (6,159) 61�6 (3�2) Falls� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � E880�0–E886�9,E888 13,199 (2,126) 14�3 (1�6) Exposure to radiation � � � � � � � � � � � � � � � � � � � � � � � � E926 11,709 (2,123) 12�7 (2�3) Natural and environmental factors � � � � � � � � � � � � � � E900–E909,E928�0–E928�2 5,553 (1,439) 6�0 (1�5) Overexertion and strenuous movements � � � � � � � � � E927 5,462 (1,425) 5�9 (1�3) Cutting or piercing instruments or objects� � � � � � � � � E920 * ��� * ��� Motor vehicle traffic � � � � � � � � � � � � � � � � � � � � � � � � � � E810–E819 4,612 (916) 5�0 (0�9) Struck against or struck accidentally

by objects or persons � � � � � � � � � � � � � � � � � � � � � � � E916–E917 3,557 (1,017) 3�9 (0�9) Poisoning � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � E850–E869 * ��� * ��� Other mechanism3 � � � � � � � � � � � � � � � � � � � � � � � � � � E800–E807(�0–�3,�8–�9),E820–E825, 8,157 (1,227) 8�8 (1�1)

E826–E848,E890–E899,E910–E915, E918–E919,E921,E922,E923–E925, E928�3–�5,�8,E929�0–�5,�8

Mechanism unspecifed and blank � � � � � � � � � � � � � � E887,E928�9,E929�9 3,243 (489) 3�5 (0�5) Intentional injury or poisoning1 � � � � � � � � � � � � � � � � � � � … 1,477 (424) 1�6 (0�5) Injury or poisoning—unknown intent1 � � � � � � � � � � � � � � … 23,180 (3,028) 25�1 (2�7) Adverse effect of medical treatment, or surgical care

or adverse effect of medicinal drug1 � � � � � � � � � � � � � � … 10,717 (1,883) 11�6 (2�0) Medical or sugical complication � � � � � � � � � � � � � � � � E870–E879 *4,075 (1,610) *4�4 (1�7) Adverse drug effects � � � � � � � � � � � � � � � � � � � � � � � � � E930–E949 2,416 (639) 2�6 (0�7) Other and blank4 � � � � � � � � � � � � � � � � � � � � � � � � � � � � … 4,226 (720) 4�6 (0�8)

��� Category not applicable� * Figure does not meet standards of reliability or precision� 1The defnition of visits related to injury or trauma, overdose or poisoning, and adverse effect of medical or surgical treatment or adverse effect of medicinal drug used in this table is based on auto-mated Patient Record form entries for patient’s reason for visit, diagnosis, and cause of injury� Starting in 2014, up to fve reasons and diagnoses and up to three causes could be coded for each visit� Categories shown refect the classifcations used� Reason for visit was coded using “A Reason for Visit Classifcation for Ambulatory Care (RVC)” as defned in the 2015 public use fle documentation, available from ftp://ftp�cdc�gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2015�pdf� Diagnosis codes are based on the International Classifcation of Diseases, Ninth Revision, Clinical Modifcation (ICD–9–CM) (U�S� Department of Health and Human Services, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services� Official version: Internation-al Classifcation of Diseases, Ninth Revision, Clinical Modifcation, Sixth Edition� DHHS Pub No� (PHS) 11–1260)� Visits related to injury or trauma, overdose or poisoning, and adverse effect of medical or surgical treatment or adverse effect of medicinal drug accounted for 9�3% (SE = 0�7) of all office visits in 2015� For more information, see the 2015 NAMCS Public Use Data File documentation� 2Mechanism of injury is based on the “Supplementary Classifcation of External Cause of Injury or Poisoning” in the International Classifcation of Diseases, Ninth Revision, Clinical Modifcation (ICD–9–CM), U�S� Department of Health and Human Services, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services� Official version: International Classifcation of Diseases, Ninth Revision, Clinical Modifcation, Sixth Edition� DHHS Pub No� (PHS) 11–1260� Data are based on frst-listed external cause of injury or poisoning� Up to three external cause of injury or poisoning codes could be collected per visit� 3Includes injuries caused by drowning, frearms, fre and fames, pedal cycle (nontraffic), motor vehicle (nontraffic and other), suffocation, foreign bodies, other transportation, caught accidentally between objects, machinery, and other mechanism� 4Other includes visits that were classifed as adverse effects of medical or surgical care or adverse effect of medicinal drug based on the PRF in conjunction with frst-, second-, third-, fourth-, or ffth-listed reason for visit and diagnosis codes related to adverse effects but that could not be classifed as such based on frst-listed external cause of injury or poisoning�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 19. Presence of selected chronic conditions at office visits, by patient age and sex: United States, 2015

Chronic conditions1 Total Under 45 years 45–64 years 65–74 years 75 years and over Female Male

Percent distribution (standard error of percent)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 100�0 ��� 100�0 ��� 100�0 ��� 100�0 ��� 100�0 ��� 100�0 ��� 100�0 ���

None� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 37�3 (1�6) 65�8 (2�2) 24�6 (1�4) 16�3 (1�3) 12�5 (1�3) 39�5 (1�7) 34�1 (2�0) One or more chronic conditions 61�0 (1�7) 31�8 (2�1) 73�8 (1�5) 82�9 (1�4) 86�4 (1�4) 59�0 (1�7) 63�9 (2�0)

One � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 24�6 (1�0) 22�2 (1�6) 30�1 (1�3) 22�0 (1�5) 22�3 (1�9) 25�6 (1�1) 23�2 (1�1) Two 14�6 (0�8) 6�3 (0�7) 19�0 (1�1) 20�9 (1�4) 20�4 (1�8) 13�4 (0�6) 16�4 (1�4) Three or more � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 21�8 (1�5) 3�4 (0�4) 24�8 (1�8) 40�1 (2�3) 43�7 (3�3) 20�1 (1�4) 24�3 (2�0)

Blank� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1�7 (0�3) 2�4 (0�7) 1�6 (0�3) 0�8 (0�2) 1�1 (0�3) 1�5 (0�3) 2�0 (0�5)

Hypertension 29�9 (1�6) 6�2 (0�7) 34�7 (1�7) 51�6 (2�5) 57�5 (2�9) 27�0 (1�5) 34�1 (2�1) Hyperlipidemia 20�2 (1�5) 3�4 (0�7) 25�6 (2�1) 36�7 (2�2) 34�8 (2�9) 17�5 (1�3) 24�1 (2�0) Arthritis � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 16�0 (1�5) 4�1 (0�5) 18�9 (2�0) 25�6 (2�3) 30�1 (3�2) 16�9 (1�6) 14�6 (1�5) Diabetes mellitus (DM) � � � � � � � � � � � � � � � � � � � � � � � � � � � 15�2 (0�9) 3�3 (0�6) 19�9 (1�5) 26�8 (1�5) 23�8 (1�5) 13�6 (1�0) 17�6 (1�2)

Diabetes mellitus (DM), Type 1 � � � � � � � � � � � � � � � � � � � 0�6 (0�1) 0�2 (0�0) 1�2 (0�3) 0�8 (0�2) *0�6 (0�2) 0�5 (0�1) 0�8 (0�2) Diabetes mellitus (DM), Type 2 � � � � � � � � � � � � � � � � � � � 8�4 (0�8) 1�6 (0�3) 10�3 (1�1) 16�5 (1�5) 13�2 (1�6) 7�7 (0�7) 9�4 (1�1) Diabetes mellitus (DM), Type unspecifed � � � � � � � � � � � 6�2 (0�6) 1�6 (0�4) 8�4 (1�0) 9�5 (1�0) 10�1 (1�4) 5�4 (0�6) 7�3 (0�9)

Depression � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 10�4 (0�7) 9�1 (0�9) 14�0 (1�2) 8�7 (1�0) 8�0 (1�4) 11�9 (0�8) 8�3 (0�8) Obesity � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 7�9 (0�6) 6�6 (0�8) 10�5 (1�0) 9�6 (1�1) 3�7 (0�6) 8�4 (0�8) 7�1 (0�7) Cancer 6�5 (0�7) 1�1 (0�3) 6�0 (0�9) 13�5 (1�6) 13�9 (1�7) 5�9 (0�8) 7�4 (0�8) Coronary artery disease (CAD), 6�4 (0�6) 0�2 (0�1) 5�1 (0�9) 13�1 (1�3) 17�6 (1�9) 4�2 (0�5) 9�5 (0�9)

ischemic heart disease (IHD), or history of myocardial infarction (MI)

Asthma � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 6�2 (0�4) 6�6 (0�6) 6�9 (0�6) 5�9 (0�8) 4�0 (0�6) 6�7 (0�5) 5�4 (0�5) Chronic kidney disease (CKD) � � � � � � � � � � � � � � � � � � � � � 4�5 (1�2) * * 3�6 (0�8) 8�2 (2�4) *13�5 (4�1) *3�8 (1�2) 5�4 (1�3) Chronic Obstructive pulmonary disease (COPD) � � � � � � � 3�2 (0�3) 0�5 (0�1) 2�8 (0�5) 6�8 (1�0) 7�4 (1�0) 3�0 (0�4) 3�6 (0�5) Obstructive sleep apnea (OSA) 2�6 (0�3) 1�1 (0�2) 3�7 (0�4) 4�3 (0�7) 2�4 (0�4) 2�0 (0�3) 3�4 (0�4) Osteoporosis� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2�5 (0�2) * * 1�8 (0�3) 5�9 (0�9) 6�4 (0�9) 3�7 (0�4) 0�7 (0�2) Substance abuse or dependence� � � � � � � � � � � � � � � � � � � 2�3 (0�3) 1�9 (0�3) 3�7 (0�6) 1�4 (0�3) *1�2 (0�5) 1�8 (0�3) 3�0 (0�4) Cerebrovascular disease, history of stroke (CVA),

or transient ischemic attack (TIA) � � � � � � � � � � � � � � � � � � 1�8 (0�2) * * 1�0 (0�2) 3�1 (0�5) 6�0 (1�0) 1�8 (0�3) 1�7 (0�2) Congestive heart failure (CHF)� � � � � � � � � � � � � � � � � � � � � 1�6 (0�3) * * 1�2 (0�3) 3�6 (0�8) 4�6 (0�7) 1�7 (0�4) 1�6 (0�2) Alzheimer’s disease and dementia� � � � � � � � � � � � � � � � � � 0�9 (0�2) * * * * 1�1 (0�3) 4�4 (1�0) 1�0 (0�2) 0�9 (0�2) Alcohol misuse, abuse or dependence� � � � � � � � � � � � � � � 0�6 (0�1) 0�6 (0�1) 0�8 (0�2) 0�6 (0�2) * * 0�4 (0�1) 1�0 (0�2) History of pulmonary embolism (PE),

deep vein thrombosis (DVT), or venous thromboembolism (VTE) 0�6 (0�1) * * *0�8 (0�3) *1�0 (0�4) 1�1 (0�3) 0�5 (0�1) 0�8 (0�2)

Autism spectrum disorder� � � � � � � � � � � � � � � � � � � � � � � � � 0�2 (0�1) 0�5 (0�1) * * * * * * * * *0�4 (0�1) HIV infection and AIDS � � � � � � � � � � � � � � � � � � � � � � � � � � � *0�2 (0�1) * * * * * * * * * * *0�3 (0�1) End-stage renal disease (ESRD) � � � � � � � � � � � � � � � � � � � *0�2 (0�1) * * * * * * * * * * *0�2 (0�1)

��� Category not applicable� * Figure does not meet standards of reliability or precision� 1Presence of chronic conditions was based on the checklist of chronic conditions and reported diagnoses� Combined total visits by patients with chronic condtions and percent of visits exceeds 100% because more than one chronic condition may be reported per visit�

NOTE: Numbers may not add to totals because more than one chronic condition may be reported per visit�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 20. Presence of selected chronic conditions at office visits, by selected states: United States, 2015

Selected states Hypertension Hyperlipidemia Arthritis Diabetes1 Depression Obesity Asthma Cancer COPD2 Osteoporosis

Percent of visits (standard error of percent)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � 30�0 (2�1) 21�3 (1�8) 17�1 (2�0) 15�8 (1�1) 9�6 (0�8) 8�1 (0�8) 6�4 (0�5) 6�7 (0�9) 3�5 (0�4) 2�6 (0�3)

State

Arizona � � � � � � � � � � � � � � � � � � � � � � � � � � 27�3 (4�5) 15�2 (3�2) 12�7 (2�7) 15�2 (2�6) 10�6 (2�1) *5�6 (1�8) 6�3 (1�4) 5�6 (1�5) * ��� * ��� California 34�0 (7�3) 23�7 (5�3) 20�0 (5�5) 20�4 (3�6) 7�2 (1�9) 7�9 (1�8) 4�9 (1�1) *5�4 (2�8) * ��� * ��� Florida� � � � � � � � � � � � � � � � � � � � � � � � � � � 42�5 (6�4) 37�0 (6�7) 19�5 (3�0) 16�1 (2�7) 6�6 (1�6) 10�3 (2�9) 7�9 (2�1) 13�3 (3�1) 8�3 (2�2) *4�7 (1�7) Georgia� � � � � � � � � � � � � � � � � � � � � � � � � � 27�7 (4�0) *13�5 (4�2) 17�3 (2�9) 13�2 (2�1) *16�6 (5�1) 4�9 (0�9) 8�4 (1�8) 6�6 (1�7) * ��� * ��� Illinois 33�4 (5�2) 18�2 (4�2) 15�8 (3�1) 15�2 (3�4) 9�7 (2�4) *7�1 (2�6) 5�0 (1�0) 5�4 (1�2) * ��� * ��� Indiana 32�2 (4�2) 24�9 (4�1) 14�1 (2�4) 18�1 (3�2) 15�2 (2�0) 10�3 (2�6) 6�7 (1�8) *9�5 (4�8) 5�7 (1�5) 2�5 (0�7) Massachusetts 16�6 (4�1) *9�6 (4�4) 12�8 (3�4) 6�7 (1�8) 17�8 (5�2) * ��� *7�5 (2�7) 5�3 (1�5) * ��� * ��� Michigan � � � � � � � � � � � � � � � � � � � � � � � � � 30�5 (3�5) 22�1 (3�3) 16�2 (2�5) 13�0 (1�7) 16�1 (4�2) 7�7 (1�5) 7�1 (0�9) 4�4 (0�8) 4�4 (0�8) *2�3 (0�7) New Jersey � � � � � � � � � � � � � � � � � � � � � � � 27�4 (5�3) 22�9 (6�6) 14�3 (3�9) 13�2 (3�2) *13�5 (6�1) 10�1 (2�5) 7�4 (1�7) * ��� * ��� * ��� New York� � � � � � � � � � � � � � � � � � � � � � � � � 25�5 (3�6) 25�7 (5�9) 17�4 (4�4) 16�3 (2�4) *5�3 (1�6) 8�0 (1�9) 6�2 (1�0) 7�3 (1�5) * ��� *3�2 (1�3) North Carolina 24�6 (4�6) 17�3 (4�3) 8�7 (2�3) 11�2 (2�9) 8�2 (1�7) 7�8 (1�7) 6�4 (1�8) *6�6 (2�1) * ��� * ��� Ohio 29�9 (5�3) 17�5 (3�8) *10�1 (3�4) 11�8 (2�9) 15�2 (3�8) *9�6 (3�9) 6�8 (1�1) 6�3 (1�2) * ��� * ��� Pennsylvania� � � � � � � � � � � � � � � � � � � � � � 32�9 (4�2) 21�2 (4�5) 14�9 (3�7) 14�8 (2�6) *9�8 (3�5) 7�7 (1�8) 6�6 (1�3) 7�5 (1�6) 3�1 (0�7) * ��� Texas 23�7 (3�7) *11�8 (3�6) *21�9 (9�1) 15�0 (2�6) 8�7 (1�4) *7�8 (3�8) 6�6 (1�4) *4�9 (1�7) *2�2 (0�7) * ��� Virginia 24�9 (6�3) *15�7 (4�8) *9�9 (3�1) 14�0 (4�2) *6�5 (2�0) 6�3 (1�9) *7�5 (3�0) *14�4 (9�3) *8�7 (3�1) * ��� Washington� � � � � � � � � � � � � � � � � � � � � � � 30�9 (4�1) 23�5 (3�6) 18�1 (3�1) 12�9 (2�1) 17�1 (2�9) 10�3 (2�5) 6�8 (1�1) 5�2 (1�1) 3�7 (1�1) 2�8 (0�7)

* Figure does not meet standards of reliability or precision� 1Diabetes includes both Type I diabetes mellitus (insulin dependent or IDDM), Type II diabetes mellitus (non-insulin dependent or NIDDM), and diabetes with type unspecifed� Excludes diabetes insipidus and gestational diabetes� 2COPD is chronic obstructive pulmonary disease�

NOTES: Presence of chronic conditions was based on the checklist of chronic conditions and reported diagnoses� Combined total visits by patients with chronic condtions and percent of visits exceeds 100% because more than one chronic condition may be reported per visit� Numbers may not add to totals because more than one chronic condition may be reported per visit�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 21. Selected services ordered or provided at office visits, by patient sex: United States, 2015

Number of visits in thousands1

(standard error in Services thousands) Both sexes Female2 Male3

Percent distribution (standard error of percent)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 (49,038) 100�0 (0�0) 100�0 (0�0) 100�0 (0�0) One or more services ordered or provided4 967,598 (48,591) 97�7 (0�5) 97�9 (0�5) 97�3 (0�5) None� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 23,211 (4,619) 2�3 (0�5) 2�1 (0�5) 2�7 (0�5)

Examinations and screenings

Skin� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 184,944 (17,327) 18�7 (1�6) 17�7 (1�6) 20�0 (1�9) Retinal or eye 149,662 (16,076) 15�1 (1�5) 14�5 (1�4) 16�0 (1�9) Neurologic 145,770 (22,465) 14�7 (2�0) 13�8 (1�7) 16�0 (2�9) Pelvic 52,258 (7,747) 5�3 (0�8) 8�9 (1�2) * ��� Foot 50,962 (10,601) 5�1 (1�0) 5�1 (1�0) 5�2 (1�1) Depression screening� � � � � � � � � � � � � � � � � � � � � � � � � � � � � 43,525 (7,964) 4�4 (0�8) 4�7 (0�7) 4�0 (1�0) Breast � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 37,671 (5,411) 3�8 (0�5) 6�0 (0�8) *0�6 (0�3) Alcohol misuse screening (includes AUDIT,

MAST, CAGE, T-ACE)� � � � � � � � � � � � � � � � � � � � � � � � � � � � *17,694 (7,665) *1�8 (0�8) *1�8 (0�8) *1�8 (0�7) Rectal � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 17,274 (3,529) 1�7 (0�4) 1�8 (0�4) 1�7 (0�4) Substance abuse screening (includes NIDA/NM ASSIST,

CAGE-AID, DAST-10) 10,782 (2,816) 1�1 (0�3) 1�2 (0�3) *0�9 (0�3) Domestic violence screening *5,436 (2,481) *0�5 (0�2) *0�6 (0�3) * ���

Vital signs

Weight 753,804 (45,727) 76�1 (1�7) 77�3 (1�7) 74�3 (2�0) Height � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 698,091 (46,892) 70�5 (2�0) 71�0 (2�1) 69�6 (2�2) Blood pressure � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 677,507 (47,416) 68�4 (2�0) 70�9 (2�0) 64�7 (2�4) Temperature � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 383,829 (39,819) 38�7 (2�9) 37�6 (3�1) 40�3 (3�1)

Laboratory tests

Complete blood count (CBC) 130,395 (18,298) 13�2 (1�5) 14�2 (2�0) 11�7 (1�2) Lipids or cholesterol 101,742 (16,199) 10�3 (1�4) 10�5 (1�8) 10�0 (1�1) Urinalysis (UA) 99,152 (13,957) 10�0 (1�3) 11�4 (1�8) 8�0 (1�0) Comprehensive metabolic panel (CMP) � � � � � � � � � � � � � � � 97,237 (17,445) 9�8 (1�5) 10�0 (1�8) 9�5 (1�3) Glycohemoglobin (HgbA1C)� � � � � � � � � � � � � � � � � � � � � � � � 69,212 (12,547) 7�0 (1�1) 7�4 (1�6) 6�4 (0�9) TSH or thyroid panel� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 56,184 (8,312) 5�7 (0�7) 6�7 (1�0) 4�1 (0�5) Basic metabolic panel (BMP) � � � � � � � � � � � � � � � � � � � � � � � 41,147 (6,860) 4�2 (0�7) 4�5 (1�0) 3�7 (0�6) Glucose 36,263 (8,687) 3�7 (0�9) 4�5 (1�3) 2�5 (0�6) Creatinine or renal function panel� � � � � � � � � � � � � � � � � � � � 28,643 (7,493) 2�9 (0�7) *3�1 (1�0) 2�6 (0�7) Pap test� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 28,450 (5,312) 2�9 (0�5) 4�9 (0�8) * ��� Vitamin D test � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 23,402 (5,455) 2�4 (0�5) 2�6 (0�5) 2�0 (0�5) Liver enzymes or hepatic function panel *21,410 (7,278) *2�2 (0�7) *2�6 (1�1) *1�5 (0�5) Prostate specifc antigen (PSA) 15,859 (2,572) 1�6 (0�2) * ��� 3�9 (0�6) HPV DNA test5 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � *13,150 (9,358) *1�3 (0�9) *1�8 (1�1) * ��� Rapid strep test� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � *12,093 (3,976) *1�2 (0�4) *1�4 (0�5) 1�0 (0�3) Hepatitis testing *11,701 (4,762) *1�2 (0�5) *1�5 (0�5) *0�7 (0�4) HIV test6 *9,981 (4,369) *1�0 (0�4) *1�2 (0�5) * ��� Chlamydia test 9,764 (2,718) 1�0 (0�3) 1�4 (0�4) * ��� Pregnancy or HCG test� � � � � � � � � � � � � � � � � � � � � � � � � � � � 8,498 (2,252) 0�9 (0�2) 1�5 (0�4) * ��� Gonorrhea test *7,964 (2,833) *0�8 (0�3) *1�1 (0�5) * ���

Culture

Urine� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 24,632 (6,779) 2�5 (0�7) *3�1 (1�0) *1�6 (0�5) Throat � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � *5,698 (2,000) *0�6 (0�2) *0�5 (0�2) *0�7 (0�3) Blood 4,475 (1,302) 0�5 (0�1) 0�5 (0�2) *0�3 (0�2) Other� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5,211 (884) 0�5 (0�1) 0�7 (0�1) 0�2 (0�0)

Procedures

Electrocardiogram (EKG or ECG)� � � � � � � � � � � � � � � � � � � � 40,886 (7,408) 4�1 (0�7) 3�5 (0�6) 5�1 (0�9) Biopsy� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 19,035 (5,260) 1�9 (0�5) 1�9 (0�5) 2�0 (0�6) Colonoscopy� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 17,531 (4,381) 1�8 (0�4) *2�0 (0�6) 1�4 (0�3) Excision of tissue 12,347 (1,327) 1�2 (0�1) 1�0 (0�1) 1�6 (0�2) Audiometry � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 10,737 (2,188) 1�1 (0�2) 0�9 (0�2) 1�3 (0�3) Spirometry *10,000 (3,544) *1�0 (0�3) *1�0 (0�4) *1�0 (0�4) Sigmoidoscopy � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � *7,576 (4,829) *0�8 (0�5) *1�2 (0�8) *0�2 (0�1) Cryosurgery (cryotherapy) 7,438 (1,321) 0�8 (0�1) 0�5 (0�1) 1�1 (0�2) Upper gastrointestinal endoscopy or EGD *6,977 (2,934) *0�7 (0�3) *1�0 (0�5) * ��� Fetal monitoring *6,458 (2,802) *0�7 (0�3) *1�1 (0�5) * ��� Cardiac stress test 6,260 (1,740) 0�6 (0�2) 0�4 (0�1) *1�0 (0�3) Tonometry� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5,677 (1,586) 0�6 (0�2) *0�6 (0�2) 0�5 (0�2) Electromyogram (EMG) *4,221 (1,892) *0�4 (0�2) *0�5 (0�3) *0�3 (0�1) Tuberculosis skin testing or PPD *3,105 (1,187) *0�3 (0�1) *0�4 (0�1) * ��� Electroencephalogram (EEG)� � � � � � � � � � � � � � � � � � � � � � � 1,246 (299) 0�1 (0�0) *0�1 (0�0) 0�1 (0�0) Peak fow * ��� * ��� * ��� * ���

See footnotes at end of table.

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 21. Selected services ordered or provided at office visits, by patient sex: United States, 2015—Con.

Number of visits in thousands1

(standard error in Services thousands) Both sexes Female2 Male3

Percent distribution (standard error of percent)

Imaging Any imaging 164,853 (16,460) 16�6 (1�2) 19�0 (1�4) 13�2 (1�2) X ray � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 58,537 (6,531) 5�9 (0�6) 5�6 (0�6) 6�3 (0�7) Ultrasound, excluding echocardiogram� � � � � � � � � � � � � � � � 49,104 (10,501) 5�0 (0�9) 6�3 (1�1) 3�1 (0�8) Mammography 22,587 (4,080) 2�3 (0�4) 3�8 (0�6) * ��� Magnetic resonance imaging (MRI) 21,309 (3,007) 2�2 (0�3) 2�2 (0�3) 2�1 (0�3) Computed tomography (CT) scan� � � � � � � � � � � � � � � � � � � � 17,428 (3,054) 1�8 (0�3) 1�8 (0�4) 1�7 (0�3) Echocardiogram � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 11,604 (2,706) 1�2 (0�3) 1�2 (0�3) 1�2 (0�3) Bone mineral density 7,724 (2,040) 0�8 (0�2) 1�2 (0�3) * ��� Other imaging� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � *4,443 (1,497) *0�4 (0�1) *0�3 (0�1) *0�6 (0�3)

Treatment

Physical therapy � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 21,330 (3,224) 2�2 (0�3) 2�4 (0�4) 1�8 (0�3) Other mental health counseling 14,949 (3,476) 1�5 (0�4) 1�5 (0�4) 1�6 (0�4) Wound care 14,325 (1,814) 1�4 (0�2) 1�3 (0�2) 1�7 (0�3) Psychotherapy 11,347 (2,619) 1�1 (0�3) 1�1 (0�3) 1�3 (0�3) Home health care � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � *10,818 (3,494) *1�1 (0�3) *1�2 (0�4) *1�0 (0�4) Cast, splint, or wrap 7,622 (1,416) 0�8 (0�1) 0�7 (0�1) 0�9 (0�2) Durable medical equipment 6,833 (1,844) 0�7 (0�2) 0�4 (0�1) *1�1 (0�4) Complementary and alternative medicine (CAM) � � � � � � � � *2,507 (1,288) *0�3 (0�1) *0�2 (0�1) * ��� Occupation therapy� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � *914 (299) *0�1 (0�0) * ��� * ��� Radiation therapy � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � * ��� * ��� * ��� * ���

Health education and counseling

Diet or nutrition � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 146,889 (16,427) 14�8 (1�5) 15�3 (1�7) 14�2 (1�5) Exercise 101,678 (15,386) 10�3 (1�3) 10�2 (1�4) 10�4 (1�4) Injury prevention � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 47,237 (8,054) 4�8 (0�8) 4�2 (0�8) 5�5 (1�0) Growth or evelopment 28,068 (5,844) 2�8 (0�6) 2�8 (0�8) 2�9 (0�6) Weight reduction� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 27,280 (3,575) 2�8 (0�3) 2�6 (0�4) 3�0 (0�4) Tobacco use or exposure 25,735 (7,098) 2�6 (0�7) 2�2 (0�6) 3�1 (0�8) Diabetes education� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 19,481 (3,729) 2�0 (0�4) 1�9 (0�4) 2�1 (0�4) Family planning or contraception 8,297 (1,765) 0�8 (0�2) 1�2 (0�3) * ��� Substance abuse counseling *6,571 (2,537) *0�7 (0�2) *0�5 (0�2) *0�8 (0�3) Asthma � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5,910 (1,486) 0�6 (0�1) 0�5 (0�1) *0�8 (0�3) Stress management � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5,413 (1,072) 0�5 (0�1) 0�6 (0�1) *0�5 (0�1) STD Prevention� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5,036 (1,361) 0�5 (0�1) 0�6 (0�2) *0�4 (0�1) Alcohol abuse counseling� � � � � � � � � � � � � � � � � � � � � � � � � � *4,032 (2,025) *0�4 (0�2) *0�3 (0�1) *0�6 (0�3) Genetic counseling� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � *2,336 (1,335) *0�2 (0�1) *0�4 (0�2) * ��� Asthma action plan given to patient *2,239 (740) *0�2 (0�1) * ��� * ���

��� Category not applicable� 0�0 Quantity more than zero but less than 0�05� * Figure does not meet standards of reliability or precision� -- Quantity zero� 1Combined total of all listed services exceeds “all visits” and percent of visits exceeds 100% because more than one service may be reported per visit� 2Based on 585,795,000 visits made by females� 3Based on 405,013,000 visits made by males� 4Includes up to nine write-in procedures from the Services item on the Patient Record Form� Procedures are coded to the International Classifcation of Diseases, Ninth Revision, Clinical Modifcation, Volume 3, Procedure Classifcation� Records with write-in procedures that overlap checkboxes (for example, procedure 93�11, “Physical therapy exercises: Assisting exercise,” which could also be coded in the checkbox for physical therapy) are edited to ensure that the check box is marked; in this way the check box always provides a summary estimate, but should not be added to the corresponding ICD–9–CM procedure to avoid double counting� Procedures that could not be included in one of the checkboxes are included in the estimated total number of visits with services, but are not shown separately� 5HPV is human papilloma virus; DNA is deoxyribonucleic acid� 6HIV is human immunodefciency virus�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 22. Initial blood pressure measurements recorded at office visits to primary care providers for adults aged 18 and over, by selected patient characteristics: United States, 2015

Initial blood pressure1

Patient characteristic Number of visits in thousands Total Not high Mildly high Moderately high Severely high

Percent distribution (standard error of percent)

All visits2 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 371,911 100�0 29�9 (1�7) 46�1 (1�6) 18�5 (1�3) 5�6 (0�9)

Age

18–24 years 28,869 100�0 54�9 (4�0) 32�3 (3�7) *10�4 (3�6) * ��� 25–44 years 103,263 100�0 43�6 (2�9) 43�6 (2�4) 10�3 (1�7) *2�6 (0�8) 45–64 years 130,766 100�0 19�4 (1�6) 50�3 (2�4) 22�9 (2�3) 7�4 (1�3) 65–74 years 57,546 100�0 22�9 (2�2) 47�7 (3�7) 24�0 (2�2) *5�3 (2�2) 75 years and over � � � � � � � � � � � � � � � � � � � � � � � � � 51,467 100�0 22�9 (2�0) 46�3 (3�9) 22�0 (2�2) *8�9 (3�4)

Sex

Female 245,420 100�0 35�6 (2�3) 45�8 (1�8) 13�8 (1�2) 4�8 (1�2) Male 126,491 100�0 18�8 (1�5) 46�6 (2�7) 27�5 (2�5) 7�1 (0�9)

Race3

White� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 273,033 100�0 31�7 (1�7) 46�4 (1�7) 17�2 (1�6) 4�8 (0�9) Black or African American 69,867 100�0 20�2 (2�6) 46�6 (2�7) 25�3 (3�1) 7�9 (1�5) Other4 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 29,011 100�0 36�3 (5�1) 41�8 (4�1) 14�7 (3�2) * ���

Ethnicity3

Hispanic or Latino� � � � � � � � � � � � � � � � � � � � � � � � � 61,851 100�0 37�2 (5�1) 37�6 (4�9) 18�5 (4�3) * ��� Not Hispanic or Latino 310,060 100�0 28�4 (1�4) 47�8 (1�5) 18�5 (1�3) 5�3 (0�8)

White� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 215,747 100�0 29�7 (1�5) 48�9 (1�7) 17�2 (1�5) 4�1 (0�7) Black or African American� � � � � � � � � � � � � � � � � 67,603 100�0 20�6 (2�5) 46�1 (2�8) 25�2 (3�2) 8�1 (1�5) Other4 26,710 100�0 37�6 (4�7) 42�9 (4�9) * ��� * ���

��� Category not applicable� * Figure does not meet standards of reliability or precision� 1Blood pressure (BP) levels were categorized using the following hierarchical defnitions: Severely high BP is defned as 160 mm Hg systolic or above, or 100 mm Hg diastolic or above� Moderately high BP is defned as 140–159 mm Hg systolic or 90–99 mm Hg diastolic� Mildly high BP is defned as 120–139 mm Hg systolic or 80–89 mm Hg diastolic� Not high BP is defned as any BP less than 120 mm Hg systolic and less than 80 mm Hg diastolic� High BP classifcation was based on the “Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC–7)�” Mildly high BP corresponds to the (JNC–7) prehypertensive range� Moderately high BP corresponds to the (JNC–7) stage 1 hypertensive range� Severely high BP corresponds to the JNC–7 stage 2 hypertensive range� 2Visits where blood pressure was taken represent 94�3% (SE = 1�2) of all office visits made to primary care specialists by adults (aged 18 and over)� 3The race groups white, black or African American, and other include persons of Hispanic and not of Hispanic origin� Persons of Hispanic origin may be of any race� Starting with 2009 data, the National Center for Health Statistics adopted the technique of model-based single imputation for NAMCS race and ethnicity data� The race imputation is restricted to three categories (white, black, and other) based on research by an internal work group and on quality concerns with imputed estimates for race categories other than white and black� The imputation technique is described in more detail in the 2015 National Ambulatory Medical Care Survey Public Use Data File documentation, available at: ftp://ftp�cdc�gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2015�pdf� For 2015, race data were missing for 27�6% of adult visits made to primary care specialists, and ethnicity data were missing for 16�5% of adult visits made to primary care specialists� 4Other race includes visits by Asian, Native Hawaiian or other Pacifc Islander, American Indian or Alaska Native, and persons with more than one race�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 23. Medication therapy and number of medications mentioned at office visits, by patient sex: United States, 2015

Number of visits in thousands1

Medication therapy1 (standard error in thousands) Both sexes Female2 Male3

Percent distribution (standard error of percent)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 (49,038) 100�0 ��� 100�0 ��� 100�0 ���

Visits with mention of medication4 � � � � � � � � � � � � � � � � � � � � � � � 755,286 (43,578) 76�2 (1�3) 76�5 (1�5) 75�9 (1�5) Visits without mention of medication � � � � � � � � � � � � � � � � � � � � � 235,523 (14,437) 23�8 (1�3) 23�5 (1�5) 24�1 (1�5)

Number of medications provided or prescribed

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 (49,038) 100�0 ��� 100�0 ��� 100�0 ���

0 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 235,523 (14,437) 23�8 (1�3) 23�5 (1�5) 24�1 (1�5) 1 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 176,873 (11,490) 17�9 (0�9) 18�7 (1�0) 16�6 (1�1) 2 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 124,529 (10,390) 12�6 (0�7) 12�7 (0�9) 12�3 (0�7) 3 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 94,793 (8,203) 9�6 (0�5) 9�1 (0�6) 10�2 (0�8) 4 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 65,726 (5,153) 6�6 (0�4) 6�1 (0�6) 7�4 (0�6) 5 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 52,756 (4,437) 5�3 (0�4) 5�4 (0�5) 5�2 (0�4) 6 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 43,980 (4,463) 4�4 (0�4) 4�4 (0�4) 4�6 (0�5) 7 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 37,156 (3,794) 3�8 (0�3) 4�1 (0�5) 3�2 (0�4) 8 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 30,389 (2,990) 3�1 (0�3) 3�2 (0�4) 2�9 (0�3) 9 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 25,144 (3,137) 2�5 (0�3) 2�6 (0�3) 2�4 (0�3) 10 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 19,611 (2,578) 2�0 (0�2) 2�0 (0�3) 1�9 (0�3) 11 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 16,780 (1,860) 1�7 (0�2) 1�7 (0�2) 1�7 (0�2) 12 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 14,696 (3,237) 1�5 (0�3) 1�2 (0�2) 1�9 (0�6) 13 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 11,102 (1,927) 1�1 (0�2) 1�2 (0�2) 1�0 (0�2) 14 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 7,915 (1,287) 0�8 (0�1) 0�8 (0�2) 0�8 (0�2) 15 or more � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 33,837 (4,349) 3�4 (0�4) 3�3 (0�4) 3�6 (0�5)

��� Category not applicable� 1Includes prescription drugs, over-the-counter preparations, immunizations, and desensitizing agents� 2Based on 585,795,000 visits made by females� 3Based on 405,013,000 visits made by males� 4A drug mention is documentation in a patient’s record of a drug provided, prescribed, or continued at a visit (up to 30 per visit)� Also defned as drug visits�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 24. Office drug visits and drug mentions, by physician specialty: United States, 2015

Drug visits1 Drug mentions2

Physician speciality Number in thousands

(standard error in thousands) Percent distribution

(standard error of percent) Number in thousands

(standard error in thousands) Percent distribution

(standard error of percent)

Percent of office visits with drug mentions3

(standard error of percent) Drug mention rates4

(standard error of rate)

All specialties � � � � � � � � � � � � � � � � � � � � � � � � � � � 755,286 (43,578) 100�0 ��� 3,657,642 (266,769) 100�0 ��� 76�2 (1�3) 369�2 (17�4)

General and family practice � � � � � � � � � � � � � � � � Internal medicine � � � � � � � � � � � � � � � � � � � � � � � � Pediatrics � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Obstetrics and gynecology � � � � � � � � � � � � � � � � � Ophthalmology � � � � � � � � � � � � � � � � � � � � � � � � � � Psychiatry � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Orthopedic surgery� � � � � � � � � � � � � � � � � � � � � � � Cardiovascular diseases� � � � � � � � � � � � � � � � � � � Dermatology � � � � � � � � � � � � � � � � � � � � � � � � � � � � Otolaryngology � � � � � � � � � � � � � � � � � � � � � � � � � � Urology � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Neurology � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � General surgery � � � � � � � � � � � � � � � � � � � � � � � � � All other specialties� � � � � � � � � � � � � � � � � � � � � � �

163,903 (28,434) 116,773 (25,385) 66,633 (8,816) 54,640 (10,614) 39,651 (5,201) 38,929 (8,329) 35,754 (5,859) 35,055 (7,038) 27,102 (4,334) 15,621 (2,459) 15,273 (2,066) 12,463 (2,872) 9,727 (1,877)

123,763 (25,480)

21�7 (3�3) 15�5 (3�0) 8�8 (1�3) 7�2 (1�4) 5�2 (0�7) 5�2 (1�1) 4�7 (0�8) 4�6 (0�9) 3�6 (0�6) 2�1 (0�3) 2�0 (0�3) 1�7 (0�4) 1�3 (0�3)

16�4 (3�0)

869,427 (141,910) 733,527 (190,288) 167,576 (25,277) 168,049 (36,698) 176,307 (27,765) 113,183 (24,041) 139,084 (23,459) 258,006 (59,119) 104,961 (19,225) 71,267 (14,393) 76,974 (11,528) 67,903 (19,495) 52,129 (11,901)

659,249 (134,813)

23�8 (3�5) 20�1 (4�4) 4�6 (0�8) 4�6 (1�0) 4�8 (0�8) 3�1 (0�7) 3�8 (0�7) 7�1 (1�6) 2�9 (0�6) 1�9 (0�4) 2�1 (0�4) 1�9 (0�5) 1�4 (0�3)

18�0 (3�3)

85�0 (2�5) 84�0 (4�4) 70�2 (2�3) 67�4 (4�9) 68�4 (4�7) 84�9 (4�1) 63�4 (4�3) 85�0 (5�4) 73�0 (2�9) 63�0 (3�7) 73�7 (3�0) 79�7 (5�2) 57�9 (5�4) 74�3 (3�8)

451�0 (38�3) 527�6 (62�9) 176�7 (13�9) 207�4 (24�6) 304�3 (41�8) 246�8 (25�2) 246�5 (29�3) 625�9 (69�9) 282�8 (25�4) 287�4 (35�2) 371�2 (32�4) 434�3 (76�5) 310�2 (45�6) 395�8 (54�8)

��� Category not applicable� 1Visits at which one or more drugs were provided or prescribed� 2A drug mention is documentation in a patient’s record of a drug provided, prescribed, or continued at a visit (up to 30 per visit)� Also defned as drug visits� 3Percent of visits that included one or more drugs provided or prescribed (number of visits divided by number of office visits multiplied by 100)� 4Average number of drugs that were provided or prescribed per 100 visits (total number of drug mentions divided by total number of visits multiplied by 100)�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 25. Twenty most frequently mentioned drugs by therapeutic drug category at office visits: United States 2015

Number of occurrences in thousands Percent of drug mentions2

Therapeutic drug category1 (standard error in thousands) (standard error of percent)

Analgesics3 � � � � � � � � � � � � � � � � � � � � � � � � � � � � 402,939 (35,239) 11�0 (0�4) Antihyperlipidemic agents� � � � � � � � � � � � � � � � � 173,523 (14,480) 4�7 (0�2) Antidepressants � � � � � � � � � � � � � � � � � � � � � � � � 166,198 (14,134) 4�5 (0�3) Vitamins � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 150,302 (13,587) 4�1 (0�2) Antidiabetic agents � � � � � � � � � � � � � � � � � � � � � � 142,685 (15,118) 3�9 (0�2) Dermatological agents � � � � � � � � � � � � � � � � � � � 139,609 (12,218) 3�8 (0�3) Anxiolytics, sedatives, and hypnotics � � � � � � � � 127,757 (10,529) 3�5 (0�2) Antiplatelet agents � � � � � � � � � � � � � � � � � � � � � � 124,670 (13,177) 3�4 (0�2) Anticonvulsants � � � � � � � � � � � � � � � � � � � � � � � � 122,286 (12,559) 3�3 (0�2) Proton pump inhibitors � � � � � � � � � � � � � � � � � � � 115,079 (13,579) 3�1 (0�3) Beta-adrenergic blocking agents � � � � � � � � � � � 106,098 (9,255) 2�9 (0�1) Vitamin and mineral combinations � � � � � � � � � � 99,127 (10,605) 2�7 (0�2) Bronchodilators� � � � � � � � � � � � � � � � � � � � � � � � � 97,887 (9,001) 2�7 (0�2) Immunostimulants � � � � � � � � � � � � � � � � � � � � � � 97,297 (14,985) 2�7 (0�4) Diuretics � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 92,510 (9,332) 2�5 (0�1) Angiotensin converting

enzyme inhibitors � � � � � � � � � � � � � � � � � � � � � � 83,966 (7,735) 2�3 (0�1) Antihistamines � � � � � � � � � � � � � � � � � � � � � � � � � 75,194 (6,194) 2�1 (0�1) Calcium channel blocking agents � � � � � � � � � � � 73,840 (7,713) 2�0 (0�1) Ophthalmic preparations � � � � � � � � � � � � � � � � � 73,150 (7,867) 2�0 (0�2) Minerals and electrolytes � � � � � � � � � � � � � � � � � 71,653 (8,256) 2�0 (0�1)

1Based on Multum Lexicon second level therapeutic drug category (see https://www�cerner�com/solutions/drug-database)� 2Based on an estimated 3,657,642,000 drug mentions� 3Includes narcotic and nonnarcotic analgesics and nonsteroidal anti-infammatory drugs�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 26. Twenty most frequently mentioned drug names at office visits, by new or continued status: United States, 2015

New Continued Unknown2

Number of mentions in thousands Percent distribution

Drug name1 (standard error in thousands) (standard error of percent) Total Percent distribution (standard error of percent) Therapeutic drug category3

All drug mentions � � � � � � � � � � � � � � � � � � � � � � � � 3,657,642 (266,769) 100�0 ��� 100�0 20�0 (1�5) 79�1 (1�6) 0�9 (0�2) ���

Aspirin� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 103,951 (10,194) 2�8 (0�1) 100�0 4�1 (0�8) 95�2 (1�0) *0�7 (0�3) Analgesics, Antiplatelet agents Multivitamin� � � � � � � � � � � � � � � � � � � � � � � � � � � � � 77,015 (8,404) 2�1 (0�2) 100�0 4�8 (0�9) 94�5 (0�9) *0�7 (0�3) Vitamin and mineral combinations Omeprazole � � � � � � � � � � � � � � � � � � � � � � � � � � � � 62,408 (6,919) 1�7 (0�1) 100�0 10�8 (2�0) 88�9 (2�0) *0�3 (0�1) Proton pump inhibitors

Angiotensin converting Lisinopril � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 60,917 (6,014) 1�7 (0�1) 100�0 6�8 (1�5) 92�5 (1�6) *0�7 (0�3) enzyme inhibitors Albuterol � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 59,480 (6,041) 1�6 (0�1) 100�0 16�6 (3�3) 82�4 (3�3) *0�9 (0�4) Bronchodilators Levothyroxine � � � � � � � � � � � � � � � � � � � � � � � � � � � 58,081 (6,143) 1�6 (0�1) 100�0 4�6 (1�1) 94�8 (1�1) *0�6 (0�2) Thyroid hormones Atorvastatin� � � � � � � � � � � � � � � � � � � � � � � � � � � � � 53,372 (4,709) 1�5 (0�1) 100�0 6�5 (1�8) 92�7 (1�8) *0�9 (0�4) Antihyperlipidemic agents Amlodipine � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 50,894 (4,958) 1�4 (0�1) 100�0 9�1 (2�5) 90�3 (2�5) *0�6 (0�2) Calcium channel blocking agents Metoprolol � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 50,373 (4,544) 1�4 (0�1) 100�0 5�5 (1�2) 93�4 (1�3) *1�1 (0�4) Beta-adrenergic blocking agents Metformin � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 46,660 (4,508) 1�3 (0�1) 100�0 6�3 (1�5) 93�1 (1�5) *0�6 (0�3) Antidiabetic agents Acetaminophen-hydrocodone� � � � � � � � � � � � � � � 46,033 (8,990) 1�3 (0�2) 100�0 20�6 (5�7) 78�9 (5�8) *0�5 (0�3) Analgesics Simvastatin � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 43,262 (4,347) 1�2 (0�1) 100�0 5�6 (1�5) 94�1 (1�6) *0�3 (0�2) Antihyperlipidemic agents Omega-3 polyunsaturated fatty acids � � � � � � � � � 40,252 (4,667) 1�1 (0�1) 100�0 *4�4 (1�6) 95�1 (1�6) *0�5 (0�2) Nutraceutical products Ibuprofen� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 40,154 (4,063) 1�1 (0�1) 100�0 25�4 (2�8) 74�4 (2�8) *0�1 (0�1) Analgesics Hydrochlorothiazide � � � � � � � � � � � � � � � � � � � � � � 36,645 (4,529) 1�0 (0�1) 100�0 *14�6 (5�1) 84�9 (5�1) *0�5 (0�3) Diuretics Losartan � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 36,605 (4,497) 1�0 (0�1) 100�0 *12�3 (3�9) 87�5 (3�8) *0�2 (0�1) Angiotensin II inhibitors Gabapentin � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 35,461 (4,421) 1�0 (0�1) 100�0 10�5 (2�7) 86�5 (2�8) *3�1 (1�9) Anticonvulsants Furosemide� � � � � � � � � � � � � � � � � � � � � � � � � � � � � 35,382 (4,217) 1�0 (0�1) 100�0 8�0 (1�9) 91�5 (1�9) *0�5 (0�2) Diuretics Acetaminophen� � � � � � � � � � � � � � � � � � � � � � � � � � 34,986 (4,367) 1�0 (0�1) 100�0 24�2 (3�9) 75�0 (3�9) *0�8 (0�3) Analgesics Ergocalciferol � � � � � � � � � � � � � � � � � � � � � � � � � � � 34,948 (3,424) 1�0 (0�1) 100�0 12�2 (2�1) 87�3 (2�1) *0�5 (0�2) Vitamins Other� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2,650,765 (193,899) 72�5 (0�6) 100�0 23�9 (1�8) 75�2 (1�8) *1�0 (0�2) Other

��� Category not applicable� * Figure does not meet standards of reliability or precision� 1Based on Multum Lexicon terminology, drug name refects the active ingredient(s) of a drug provided, prescribed, or continued� 2Unknown includes drugs provided or prescribed that did not have either the new drug or continued drug checkboxes marked� 3Based on Multum Lexicon second-level therapeutic drug category (see https://www�cerner�com/solutions/drug-database)�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 27. Providers seen at office visits: United States, 2015

Number of visits in thousands1 Percent of visits Type of provider (standard error in thousands) (standard error of percent)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 (49,038) ��� ���

Physician � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 980,750 (48,769) 99�0 (0�2) R�N�2 or L�P�N�3 � � � � � � � � � � � � � � � � � � � � � � � � � 175,988 (27,226) 17�8 (2�5) Physician assistant � � � � � � � � � � � � � � � � � � � � � � 74,786 (19,105) 7�5 (1�8) Nurse practitioner or midwife � � � � � � � � � � � � � � *30,845 (10,413) *3�1 (1�0) Mental health provider � � � � � � � � � � � � � � � � � � � *4,234 (1,425) *0�4 (0�1) Other provider� � � � � � � � � � � � � � � � � � � � � � � � � � 340,604 (36,922) 34�4 (2�9) Blank� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2,169 (586) 0�2 (0�1)

��� Category not applicable� * Figure does not meet standards of reliability or precision� 1Combined total of individual providers exceeds “all visits” and “percent of visits” exceeds 100%, because more than one provider may be reported per visit� The sample of visits was drawn from all scheduled visits to a sampled physician during the 1-week reporting period� However, at 1% of these visits, the physician was not seen; instead, the patient saw another provider� 2R�N� is registered nurse� 3L�P�N� is licensed practical nurse�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 28. Disposition of office visits: United States, 2015

Disposition Number of visits in thousands1

(standard error in thousands) Percent of visits

(standard error of percent)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 (49,038) ��� ���

Return to referring physician� � � � � � � � � � � � � � � � Refer to other physician � � � � � � � � � � � � � � � � � � � Return in less than 1 week � � � � � � � � � � � � � � � � � Return in 1 week to less than 2 months � � � � � � � Return in 2 months or greater� � � � � � � � � � � � � � � Return at unspecifed time � � � � � � � � � � � � � � � � � Return as needed (p�r�n�) � � � � � � � � � � � � � � � � � � Refer to emergency room/

Admit to hospital � � � � � � � � � � � � � � � � � � � � � � � � Other disposition� � � � � � � � � � � � � � � � � � � � � � � � � Blank� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

29,287 (4,597) 81,808 (10,749) 35,022 (4,282)

305,110 (19,999) 270,959 (17,023) 55,298 (6,573)

226,859 (26,647)

6,798 (1,403) 86,435 (12,309) 16,027 (3,000)

3�0 (0�5) 8�3 (0�9) 3�5 (0�4)

30�8 (1�6) 27�3 (1�4) 5�6 (0�6)

22�9 (2�2)

0�7 (0�1) 8�7 (1�2) 1�6 (0�3)

��� Category not applicable� 1Combined total of individual dispositions exceeds “all visits,” and “percent of visits” exceeds 100% because more than one disposition may be reported per visit�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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Table 29. Time spent with physician: United States, 2015

Number of visits in thousands Percent distribution Time spent with physician (standard error in thousands) (standard error of percent)

All visits� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 990,808 ��� 100�0 ���

Visits at which no physician was seen � � � � � � � � � � � 10,058 (1,663) 1�0 (0�2) Visits at which a physician was seen � � � � � � � � � � � � 980,750 (48,769) 99�0 (0�2)

Total1� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 980,750 ��� 100�0 ���

1–5 minutes � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 9,452 (2,339) 1�0 (0�2) 6–10 minutes � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 85,784 (13,024) 8�7 (1�3) 11–15 minutes� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 326,626 (27,844) 33�3 (2�1) 16–30 minutes � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 411,324 (24,603) 41�9 (1�6) 31–60 minutes � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 138,070 (11,430) 14�1 (1�0) 61 minutes and over � � � � � � � � � � � � � � � � � � � � � � � � � 9,494 (2,193) 1�0 (0�2)

��� Category not applicable� 1Time spent with physician was reported only for visits where a physician was seen� Time spent with physician was missing for 30�4% of visits where a physician was seen� Estimates presented include imputed values for missing data�

NOTE: Numbers may not add to totals because of rounding�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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Table 30. Time spent with physician, by physician specialty: United States, 2015

Mean time in minutes spent with physician

Physician specialty (standard error of mean)1 25th percentile Median 75th percentile

All visits� � � � � � � � � � � � � � � � � � � � � � � 22�8 (0�4) 14�4 19�2 29�2

Psychiatry � � � � � � � � � � � � � � � � � � � � � 34�3 (1�7) 19�9 29�7 44�8 Neurology � � � � � � � � � � � � � � � � � � � � � 28�9 (2�6) 15�0 25�0 39�2 Ophthalmology � � � � � � � � � � � � � � � � � 28�8 (2�9) 14�5 20�1 34�2 General surgery � � � � � � � � � � � � � � � � 22�8 (1�2) 14�4 19�0 29�2 Cardiovascular diseases� � � � � � � � � � 22�6 (1�2) 14�5 19�1 29�1 Internal medicine � � � � � � � � � � � � � � � 22�2 (1�4) 14�5 19�1 29�2 Urology � � � � � � � � � � � � � � � � � � � � � � � 22�1 (0�9) 14�3 16�4 29�2 Orthopedic surgery� � � � � � � � � � � � � � 21�7 (1�4) 14�3 15�8 29�0 Pediatrics � � � � � � � � � � � � � � � � � � � � � 21�7 (1�1) 14�4 19�1 27�9 Otolaryngology � � � � � � � � � � � � � � � � � 21�1 (0�7) 14�3 16�4 24�6 General and family practice � � � � � � � 20�3 (0�8) 14�1 15�8 24�7 Obstetrics and gynecology � � � � � � � � 20�1 (0�8) 14�2 15�0 23�8 Dermatology � � � � � � � � � � � � � � � � � � � 17�9 (0�8) 11�5 14�7 19�7 All other specialities � � � � � � � � � � � � � 24�0 (1�4) 14�5 19�7 29�2

1Only visits where a physician was seen are included� Time spent with physician was missing for 30�4% of visits where physician was seen� Estimates presented include imputed values for missing data�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 31. Physician characteristics, by response status: United States, 2015

Total in-scope Responding Nonresponding Number of sample percent physician percent physician percent Physician

sampled in-scope distribution3 distribution4 distribution5 response rate Particpation rate Physician characteristic1 physicians2 (weighted) (weighted) (weighted) (weighted)6 Participants7 (weighted)8

All office-based physicians � � � � � � � � � � 4,910 100�0 100�0 100�0 0�296 1,737 0�365

Age

Under 50 years � � � � � � � � � � � � � � � � � � � 1,896 39�3 40�2 38�9 0�303 654 0�353 50 years and over � � � � � � � � � � � � � � � � � 3,014 60�7 59�8 61�1 0�291 1,083 0�373

Sex

Male � � � � � � � � � � � � � � � � � � � � � � � � � � � 3,591 67�6 67�7 67�6 0�296 1,259 0�362 Female � � � � � � � � � � � � � � � � � � � � � � � � � 1,319 32�4 32�3 32�4 0�295 478 0�371

Metropolitan status9

MSA � � � � � � � � � � � � � � � � � � � � � � � � � � � 4,550 91�8 92�7 91�4 0�299 1,617 0�368 Non-MSA � � � � � � � � � � � � � � � � � � � � � � � 360 8�2 7�3 8�6 0�263 120 0�328

Type of doctor

Doctor of medicine � � � � � � � � � � � � � � � � 4,707 94�7 95�1 94�6 0�297 1,671 0�364 Doctor of osteopathy� � � � � � � � � � � � � � � 203 5�3 4�9 5�4 0�277 66 0�388

Physician specialty10,11

General or family practice� � � � � � � � � � � 358 18�4 18�9 18�2 0�303 147 0�403 Internal medicine � � � � � � � � � � � � � � � � � 275 13�1 9�6 14�6 0�217 90 0�309 Pediatrics � � � � � � � � � � � � � � � � � � � � � � � 274 8�9 13�0 7�2 0�432 128 0�504 General surgery � � � � � � � � � � � � � � � � � � 263 3�0 3�2 3�0 0�314 97 0�360 Obstetrics and gynecology � � � � � � � � � � 383 7�2 6�9 7�3 0�284 141 0�359 Orthopedic surgery� � � � � � � � � � � � � � � � 396 4�7 4�0 5�0 0�251 129 0�313 Cardiovascular diseases� � � � � � � � � � � � 342 3�9 4�4 3�7 0�338 107 0�360 Dermatology � � � � � � � � � � � � � � � � � � � � � 406 2�2 2�2 2�2 0�291 146 0�349 Urology � � � � � � � � � � � � � � � � � � � � � � � � � 396 2�0 1�8 2�0 0�277 139 0�376 Psychiatry � � � � � � � � � � � � � � � � � � � � � � � 278 5�8 4�7 6�2 0�240 90 0�358 Neurology � � � � � � � � � � � � � � � � � � � � � � � 302 2�0 1�6 2�2 0�239 86 0�284 Ophthalmology � � � � � � � � � � � � � � � � � � � 418 3�8 3�7 3�8 0�294 159 0�377 Otolaryngology � � � � � � � � � � � � � � � � � � � 411 1�9 1�9 1�9 0�288 135 0�338 All other specialties� � � � � � � � � � � � � � � � 408 23�2 24�0 22�8 0�307 143 0�337

Specialty type11

Primary care � � � � � � � � � � � � � � � � � � � � � 1,248 46�5 47�0 46�3 0�299 491 0�389 Surgical� � � � � � � � � � � � � � � � � � � � � � � � � 2,032 20�7 20�0 20�9 0�287 715 0�340 Medical � � � � � � � � � � � � � � � � � � � � � � � � � 1,630 32�8 32�9 32�7 0�297 531 0�347

Practice type

Solo � � � � � � � � � � � � � � � � � � � � � � � � � � � 1,018 21�4 22�4 21�0 0�310 371 0�425 Two physicians � � � � � � � � � � � � � � � � � � � 219 4�7 4�0 5�0 0�254 80 0�343 Group or HMO12 � � � � � � � � � � � � � � � � � � 2,935 57�6 56�7 58�1 0�291 1,030 0�346 Medical school or government � � � � � � � 109 2�0 1�8 2�0 0�272 33 0�325 Other� � � � � � � � � � � � � � � � � � � � � � � � � � � 168 3�3 3�6 3�1 0�326 64 0�397 Unclassifed � � � � � � � � � � � � � � � � � � � � � 461 11�0 11�5 10�8 0�309 159 0�354

Annual visit volume10

0–25 percentile � � � � � � � � � � � � � � � � � � � 1,228 22�5 35�1 17�1 0�463 559 0�528 26–50 percentile � � � � � � � � � � � � � � � � � � 1,228 23�0 22�1 23�4 0�284 376 0�353 51–75 percentile � � � � � � � � � � � � � � � � � � 1,227 32�2 18�7 37�9 0�172 298 0�209 76–100 percentile � � � � � � � � � � � � � � � � � 1,227 22�3 24�1 21�5 0�320 504 0�440

1Characteristic information is from a combination of sources: the master fles of the American Medical Association, the American Osteopathic Association, and the NAMCS physician induction form� 2In-scope physicians are those who verifed that they were nonfederal and involved in direct patient care in an office-based practice, excluding the specialties of radiology, pathology, and anesthesiology� 3Total in-scope sample physicians are those who were selected from (a) the master fles of the American Medical Association, and (b) the American Osteopathic Association� In-scope determination was also used for inclusion in NAMCS� 4Responding physicians are those who were in-scope and participated fully in completion of PRFs or were unavailable to complete PRFs� 5Nonresponding physicians are those who were in-scope and participated minimally or refused to participate in the NAMCS� 6Values represent a response rate among physicians selected from the core office-based sample� Numerator is the number of in-scope physicians from the physician sample who participated fully in NAMCS or who did not see any patients during their sampled reporting week� Denominator is all in-scope physicians selected from the physician sample� 7Participants are physicians for whom at least one Patient Record form was completed (full and minimal responders) and also include physicians who saw no patients during their sample week� 8Participation rate is the number of participants divided by the number of in-scope physicians� 9MSA is metropolitan statistical area� 10Chi-square test of association is statistically signifcant (p<0�05) between physician response and indicated physician characteristic� 11Physician specialty type defned in the 2015 National Ambulatory Medical Care Survey Public Use Data File Documentation (see ftp://ftp�cdc�gov/pub/Health_Statistics/NCHS/Dataset_Documentation/ NAMCS/doc2015�pdf)� 12HMO is health maintenance organization�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics

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National Ambulatory Medical Care Survey: 2015 State and National Summary Tables

Table 32. State location of physician office, by response status: United States, 2015

Total in-scope Number of sample Percent sampled percent Percent distribution Response Participation in-scope distribution distribution of of non- rate6 rate8

Region and state1 physicians2,3 (weighted) respondents4 respondents5 (weighted) Participants7 (weighted)

Total � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4,910 55�3 16�4 38�9 0�296 1,737 0�365

Northeast

Massachusetts � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 178 2�3 1�6 2�6 0�204 52 0�278 New Jersey � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 258 4�0 2�0 4�8 0�150 59 0�234 New York� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 286 7�8 5�9 8�6 0�225 90 0�347 Pennsylvania� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 239 3�9 4�2 3�7 0�326 79 0�382 Remainder states (CT, ME, NH, RI, VT) � � � � � � � � � � � � � � � � � � � � 262 3�0 2�8 3�0 0�278 97 0�362

224 3�7 3�1 3�9 0�248 67 0�295 305 2�4 2�1 2�6 0�258 107 0�297 244 3�0 5�7 1�9 0�558 129 0�577 231 3�4 2�4 3�8 0�206 70 0�264

� � � � � � � � � 289 8�4 8�6 8�3 0�305 96 0�330

206 5�4 4�4 5�8 0�243 93 0�436 178 1�9 2�8 1�5 0�441 98 0�580 161 1�8 0�9 2�2 0�152 61 0�324 279 8�1 6�4 8�9 0�232 72 0�252 239 2�8 2�4 2�9 0�261 85 0�352 272 12�7 16�9 11�0 0�393 130 0�515

251 1�9 2�0 1�9 0�302 79 0�359 288 14�8 15�2 14�6 0�304 82 0�319 232 2�4 2�7 2�3 0�329 82 0�330

Midwest

Illinois � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Indiana � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Michigan � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Ohio � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Remainder States (IA, KS, NE, ND, SD, MN, MO, WI)

South

Florida� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Georgia� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � North Carolina � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Texas � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Virginia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Remainder states (AR,AL,DE,DC,KY,MD,MS,LA,OK,SC,TN,WV) � � �

West

Arizona � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � California � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Washington� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Remainder states (CO, ID, MT, NV, NM, OR, UT, WY, AK, HI). . . . . 288 6�5 7�9 5�9 0�360 109 0�418

1Chi-square test of association is statistically signifcant (p<0�05) between physician response and state location of office where most visits were seen� 2In-scope sample physicians are those confrmed during the survey to be nonfederal and involved in direct patient care in an office-based practice, excluding the specialities of radiology, pathology, and anesthesiology� 3Total in-scope sample physicians are those who were selected from (a) the master fles of the American Medical Association, and (b) the American Osteopathic Association� In-scope determination was also used for inclusion in NAMCS� 4Responding physicians are those who were in-scope and participated fully in completion of PRFs or who saw no patients during their sample week� 5Non-responding physicians are those physicians who were in-scope and participated minimally or refused to participate in the NAMCS� 6Values represent a response rate among physicians selected from the office-based sample� Numerator is the number of in-scope physicians from the physician sample who participated fully in NAMCS or who did not see any patients during their sampled reporting week� Denominator is all in-scope physicians selected from the physician sample� 7Participants are physicians for whom at least one Patient Record form was completed (full and minimal responders) and also include physicians who saw no patients during their sample week� 8Participation rate is the number of participants divided by the number of in-scope physicians�

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2015�

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics